The first step in determining the right healthcare insurance plan for your situation is to understand your specific healthcare needs and financial situation. These factors are crucial in deciding the best plan for you.

• If you don’t visit the doctor often and maintain relatively good health, opting for a health insurance plan with a higher deductible and lower premiums may save you money. However, this type of plan may leave you vulnerable to unexpected medical bills in the event of an accident.
• If you prefer higher premiums with lower cost-sharing or require more than basic preventative medical care, you could consider plans with lower deductibles and more predictable costs.

Most states have Open Enrollment for the Affordable Care Act (ACA) health insurance from November 1st to December 15th. Some states have permanently extended open enrollment. You must be a resident of the state in which your health insurance plan is filed.

Some states with permanently extended open enrollment periods as of 2022 are:

• Colorado: November 1, 2022, through January 15, 2023
• California: November 1, 2022, to January 31, 2023
• District of Columbia: November 1, 2022, to January 31, 2023

A special enrollment period is in effect from February 15, 2021, through August 15, 2021, for individuals and families with ACA marketplace coverage in response to the Covid-19 health pandemic. This special enrollment period is applicable to residents of the 36 states served by the Health Insurance Marketplace.

Typically, the Open Enrollment period at the end of the year is the only time to buy ACA-qualified health insurance via the private market, and you cannot purchase it after the state-specific cutoff date. However, there are qualifying life events that provide a sixty-day period for enrollment.

Some individuals may qualify for Special Enrollment if they experience:

• Loss of health coverage previously provided by a parent, spouse, or another family member
• Turning 26 years old and no longer eligible to remain on a parent’s health insurance plan
• Loss of health insurance due to a parent or guardian’s job loss
• Loss of health coverage for dependents due to a family member losing health insurance through their employer
• Legal separation or divorce resulting in the loss of health insurance coverage
• Death of a family member who previously provided health insurance
• Gaining U.S. citizenship, making you eligible for an ACA marketplace insurance plan
• Membership in a federally recognized Native American Indian tribe
• Status as an Alaskan Native Claims Settlement Act (ANCSA) shareholder
• Service as an AmeriCorps State and National, VISTA, or NCCC member
• Release from incarceration

The Affordable Care Act of 2010, also known as Obamacare, outlines a list of ten essential health benefits that individual medical plans offered on the marketplace must cover to be recognized as ACA plans.

The list of legally required services in ACA health insurance plans includes outpatient, emergency services, surgery, maternity and newborn infant care, mental health services, prescription drugs, preventative and rehabilitative care, along with lab services and pediatrics. These plans typically have higher premiums and prices than non-ACA short-term health plans but offer more extensive coverage.

In most cases, a waiting period is required before your health insurance coverage begins. You won’t begin paying your premiums on new healthcare coverage until that coverage starts on January 1st. If you qualify for an ACA plan due to a qualifying life event, your coverage may not begin for at least two weeks.

The specific cost of premiums varies between different plans, and subsidies may be available. Subsidies can cover part of your premium or out-of-pocket costs if your income is below 4 times the federal poverty level. ACA plans help manage expenses with a cap on what you are required to pay. In 2020, the maximum out-of-pocket cost was $8,200 for individuals and $16,000 for families.

The ACA marketplace offers four levels of health insurance plans, each covering a different portion of your healthcare bills:

Bronze (covers approximately 60%)

Silver (covers approximately 70%)

Gold (covers approximately 80%)

 Platinum (covers approximately 90%)

Individuals enrolled through the Health Insurance Marketplace may be able to compare and lower their monthly out-of-pocket costs, making insurance plans more affordable. To qualify for tax credits, you must meet specific requirements:

• Enrolled in coverage through the marketplace, excluding “catastrophic coverage”
• Unable to obtain insurance through employer-sponsored plans
• Ineligible for government-run programs like TRICARE, CHIP, Medicaid, or Medicare
• Income is at least 100%, but not exceeding 400% of the federal poverty line
• Married and file taxes jointly
• Not listed as a dependent on anyone else’s tax return
• Not listed as a dependent on anyone else’s tax return
• Eligibility is determined by the marketplace, and you can check if you qualify by answering a few simple questions.

You can purchase indemnity or short-term health insurance at any time, but you cannot change or purchase ACA health insurance outside the Open Enrollment Period unless you experience a qualifying life event. Qualifying life events include, but are not limited to:

• Loss of health coverage due to job loss
• Having a child or adopting a child
• Moving to a new home in a different zip code or county
• Marriage
• Turning 26 and losing health insurance under your parent’s plan
• Cancellation of your current healthcare insurance plan