ACA

Affordable Care Act (ACA) plans are commonly referred to as the Obamacare Insurance Plans. Insurance companies that offer these plans are required to follow guidelines set by the government. They are “guaranteed issue” and “guaranteed renewable” to anyone that applies during the Open Enrollment Period that runs November 1 – December 15 each year. There are also Special Enrollment Periods available to anyone who experiences specific changes in their personal circumstances throughout the year, such as losing employer coverage or getting married or divorced. While rates, deductibles, out of pocket costs and benefits are set by the insurance company and vary from plan to plan as well as company to company, there is no underwriting, and you cannot be denied coverage or charged a higher premium for a pre-existing condition. The only factors that are allowed to be considered to determine the premium are county of residence, age, gender, and tobacco use. These plans are specific to geographical area. They are not an option if you are eligible for Employer Coverage that meets minimum guidelines, Medicare, Medicaid or other State Assistance programs or insurance that can provide coverage. There can be income tax consequences if you enroll in a market place plan and are later found to be eligible for other coverage. 

ACA Marketplace plans are categorized into different levels of coverage Bronze, Silver, Gold, and Platinum. For the most part, bronze plans will have higher deductibles and out-of-pocket costs with a lower premium while the platinum plans will have lower deductible and out-of-pocket costs but a higher premium. The silver and gold plans fall in between. There are also “Catastrophe” plans that are only available to someone under age 30 or individuals 30 and over who qualify for a hardship or affordability exemption. Part of the ACA legislation provided for a Premium Tax Credit to help individuals pay for a portion of the premium cost. This credit is based on your annual income as filed on your income tax return at the end of the year. It is important to estimate income as closely as possible to avoid having to repay part of the credit.

Short Term Plans

Short term plans are medical insurance plans that typically range between 182 and 364 days in length. They can usually be cancelled at any time, therefore if you are looking for coverage to get through a short period of time until other coverage starts, these may be a good option. The premiums, deductibles, copays, and other out-of-pocket expenses will vary depending on the plan and the individual insurance company. Depending on the coverage you are looking for and your specific situation in regards to income and health, they may have lower premiums. These plans are subject to underwriting and are not guaranteed to renew. They may or may not cover prescriptions and oftentimes do not cover preexisting conditions. At the end of the policy period a new application needs to be submitted and approved to continue coverage.