Healthcare isn’t one size fits all. That’s why it is important to get the plan that is the best fit for each individual or family.
Our Affordable Care Act (ACA)-licensed insurance benefits experts take the time to listen to what’s important to you. Then we look for affordable plans available in your area that meet those unique medical and lifestyle needs. We also check to see if you are eligible for tax credits to lower your monthly costs.
And we are here for you year-round, to answer your insurance questions and advocate on your behalf. Often, you can speak with the same expert who enrolled you in your plan.
Getting the coverage you need at an affordable price is important. Here are some things you should know before choosing a plan for you or your family.
If you want to continue to see and use the same doctors, hospitals, other healthcare providers, and pharmacies you have, make sure they are in the plan’s network. In-network care and medicines are covered by a health plan, but out-of-network services usually cost more or may not be covered at all.
There are several costs that you will have to pay, so it’s important to think about the total costs when you choose a plan.
Each plan has a list of medicines, called a formulary, that the insurer covers. The covered medicines are put in tiers, which determine how much your copay or coinsurance must pay.
Make a list of your current medicines and check them with the plan’s formulary to make sure they are covered and to see how much you will pay out-of-pocket for them.
ACA health plans are grouped into 4 categories: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. While you may think picking a plan with a lower monthly premium, like a bronze plan, will save you money, that may not be true. You need to think about the total costs you and your family spent last year on healthcare, including your medicines before picking a plan.
If your annual income is below 100% to 200%of the federal poverty limit, you are eligible for zero-premium coverage, depending on what plan you pick. In 2022 the limit is:
If your income is between 200% and 400% of the federal poverty level, you are eligible for substantial premium subsidies. The amount of the subsidy depends your income and what plan you pick.
If your income is above 400% of the federal poverty level, you are eligible for subsidies if your premium payments would be more than 8.5 percent of your income.
All ACA health plans cover 10 essential health benefits:
Dental and vision coverage are not considered essential health benefits for adults. Some plans do cover vision and dental care, so check your plan.
All ACA marketplace plans, unless grandfathered, must cover treatment for pre-existing medical conditions:
Grandfathered plans don’t have to cover pre-existing conditions. If you have been enrolled in the same plan since before March 23, 2010, you could be in a grandfathered plan that doesn’t have to cover pre-existing conditions or preventive care.
If you’re pregnant when you apply, your plan can’t reject you or charge you more because of your pregnancy. Pregnancy and childbirth coverage begins the day your plan starts.
Your plan must also provide breastfeeding support, counseling, and equipment for as long as you breastfeed your child. These services may be provided before and after birth.
ACA health plans must cover contraceptive methods and counseling for all women, as prescribed by a health care provider.
Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider, even if you haven’t met your deductible.
Your ACA health plan must cover services to find and prevent diseases and health problems before they get worse. These services include shots and screening tests.
Visit healthcare.gov to get see what’s covered:
Mental and behavioral health services are essential health benefits All plans must cover:
Your specific behavioral health benefits will depend on the state you live in and the health plan you choose. American Exchange can help you compare plans available to you to see what mental health and substance abuse services are covered.
Use the form below to contact an American Exchange team member.
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Medicare Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
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