Affordable Care Act Plans

ACA plans are marketplace plans that are state based and regulated by the Patient Protection Affordable Care Act law. The main advantages of these plans are that they are guaranteed issue and the rates for unhealthy people are fixed. There are a few drawbacks as these plans have limited network coverage and limited carrier options. 

The cost of these plans vary as they depends on age, household size, state, and household income. Depending on those factors, you may qualify for Advance Premium Tax Credits to reduce the cost of your insurance. On the other hand, if you do not quality, then the cost of these plans can be very expensive. 

ACA Benefits & Considerations
Benefits:
  • Prescription Coverage. Marketplace plans have prescription coverage for most brand and generic prescriptions. This is a good option if you have a pre-existing condition that requires expensive, regular medicine.

  • Preventative Care Coverage. Yearly preventative care is covered free of charge on Marketplace plans.

  • Pre-Existing Conditions Are Covered. Since Marketplace plans are covered under the Patient Protection and Affordable Care Act policy, pre-existing conditions are covered under any plan. This is important for any major condition that has reoccurring expenses.

  • Advance Premium Tax Credits (APTC). Marketplace plan costs are based on household size and income. The lower the household income and larger the family results in Advance Premium Tax Credits. APTC offset partial, or all, of the cost of the Marketplace plans in attempt to keep costs affordable. When applying for a Marketplace plan on Healthcare.gov you have to estimate how much household income you will make the next calendar year. If you understeimate, you may owe back some, or all, of the APTC's at tax time.

Considerations:
  • Possibly High Premium. Since Market-place plans cannot deny unhealthy applicants or offer lower rates to the healthy population (or underwrite plans), costs may be unaffordable. If you do not qualify for APTC then the plans can be quite high - up to $1,500+.

  • Open Enrollment Period.  Marketplace plans have designated enrollment times - generally beginning in November of each year. Then, these plans begin January 1st. If you do not enroll during the Open Enrollment Period then you would need to qualify for a Special Enrollment Period.

  • Limited Networks. Marketplace plans have networks that are defined by the insurance carrier of your choosing. These networks are generally small and limited to your state.

  • Limited Carriers. Since Marketplace plans are state-based, the carriers are limited. Each state often has 1-3 carrier options.

 

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