The Affordable Care Act requires non-grandfathered health insurance coverage in the individual and small group markets to cover essential health benefits (EHB). The law addresses health insurance coverage, health care costs, and preventive care. The ACA offers a premium tax credit to help subsidize coverage and supports innovative medical care delivery methods to lower costs. The law includes three main premises:
Subsidies (‘premium tax credits’) that lower costs for households with incomes between 100% and 400% of the federal poverty level.
Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. Not every state has expanded its Medicaid programs.
Support advanced medical care delivery methods intended to lower the costs of health care in general.
What Is the Health Insurance Marketplace?
The ACA created a Health Insurance Marketplace, a service that helps eligible consumers shop and enroll in health insurance through websites, call centers, and in-person assistance.
When you apply for individual and family plans through the Marketplace, you’ll submit income and household information. You’ll see if you qualify for:
Premium tax credits (Subsidy) that make insurance more affordable.
Health coverage through the Medicaid and Children’s Health Insurance Program (CHIP) in your state.
What Do ACA Plans Cover?
All ACA-compliant plans, including each one sold on the Health Insurance Marketplace, must cover standard “essential” health benefits including:
Prescription drugs
Rehabilitative and habilitative services and devices;
Laboratory services
Preventive and wellness services and chronic disease management; and
Pediatric services.
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health
Doctor Visit
Pre-existing conditions are covered.
〰️
Pre-existing conditions are covered. 〰️
When Can You Enroll?
Each year, there’s an Open Enrollment Period (OEP) on the Health Insurance Marketplace where you can buy switch plans. The OEP for 2023 plans has been extended from November 1 through January 15.
You don’t want to miss this period. If you miss it, you can’t enroll until the following year — unless you qualify for a Special Enrollment Period (SEP) due to change in circumstances. For example, if you get married, divorced, become a parent, or lose a job that gave you health insurance coverage, or If your income is at or below 150% FPL, you may qualify to enroll in or change Marketplace coverage through a Special Enrollment Period.
4 Metal Levels
Health plans will be standardized in four coverage tiers based on the percentage of the total allowed cost of benefit paid by a health plan on average.
Bronze
60% Covered
At this level, you’re responsible for 40% of your medical costs. The Bronze category has the lowest monthly premium, but high deductibles mean you’ll have to pay a lot out of pocket before your insurance steps in and pays.
Silver
70% Covered
At this level, you pay 30% of your medical bills. The Silver plan has a higher monthly premium than the Bronze but is still very affordable. It’s great for people who qualify for cost-sharing reductions (CSR) — a discount for deductibles and copays.
Gold
80% Covered
At the gold level, you pay 20% of your healthcare costs. The Gold plan has a high monthly premium but more of your costs will be covered when you seek treatment.
Platinum
90% Covered
At the platinum level, you pay just 10% of your medical bills, and the insurance company pays 90%. This plan has the highest monthly premium of the four categories, which means you pay lower costs and much lower deductibles when receiving care. It’s great for those who are faced with chronic conditions or significant injuries.
Healthcare Made Simple
A health insurance agent on your side allows you to explore and select the best coverage benefits for you and your family.
Our agents are trained and experienced, so that they can offer you the best option in coverage, deductibles and out-of-pocket costs. The best health plans are just a click away.
Health Insurance Rates
The only factors that can be used to vary the premium rate for a plan in the individual or small group market are:
Age
Family or Individual
Geographic location
Tobacco use
The age factor limits the company's highest rate for a 64 year old to no more than three times the cost of a 21 year old.
The total premium for family coverage generally must be determined by summing the premiums for each individual family member. For family members under age 21, the total premium includes only the premiums for no more than the three oldest covered children.
Individuals that use tobacco can be charged up to 50% more than someone that does not use tobacco.
Gender or health history can no longer be used to determine the premium.
Why Use an Insurance Advisor?
Personalized experience. One-on-one service with a licensed agent.
Open communication. If any changes in policy take place, we update you.
Simple choices. A comprehensive breakdown of any plan applicable to you.
Lifetime support. Our commitment goes beyond your initial set up. We continue to monitor your plan and provide useful recommendations as needed.
Quality Health Insurance at an Affordable Price
At A&G Professional Group LLC, we guide you and help you decide the best health coverage for you, your family, your small business, or evaluate the best alternative to your health coverage needs. We are committed to finding the best benefits for you and keeping you informed of changes that may affect your eligibility or benefits.
