Individuals and Families 

The Affordable Care Act (ACA) - also called Obamacare - is a new law helping more Americans get health insurance. This guide will help you understand how it's affecting individuals and families.

 

And if you're overwhelmed, don't worry! Just call or email us. We're trained and authorized to help.

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Most of us are required to have health insurance now, or pay a penalty. 

Unless you qualify for an exception, you'll pay a penalty if you don't have qualified health insurance starting in 2014. Qualified health insurance could be job-based coverage, private health insurance, Medicaid, Medicare, or another government-sponsored insurance plan.

 

Find out if you qualify for discounted health insurance.

Use our calculator to see if you qualify for a tax subsidy to lower the cost of your health insurance under the new law. A tax subsidy is money that the government will pay directly to your brand-name insurance company to make your insurance more affordable. 

 

Find out if you qualify for Medicaid.

 Under ACA, Medicaid has expanded to include more people. Medicaid varies by state, and not every state choose to expand the program. If your state didn't expand Medicaid, you can shop for discounted private plans instead.

 

If you have children, do they qualify for CHIP?

Since 1997, the Children's Health Insurance Program (CHIP) in each state has offered a program to help cover children whose families make too much money for Medicaid but still require some financial assistance toward health insurance. 

 

If someone in your house is over 65, they qualify for Medicare.

At age 65, you get Medicare Part A (hospitalization) at no cost and you'll pay a monthly premium for Part B (medical). Medicare is considered qualified coverage, so you don't need to make any changes to be compliant with the law. ACA made almost no changes to Medicare, except for shrinking the "donut hole" in Part D prescriptions plans over the next several years.

 

 

 

IMPROVED BENEFITS

 

You can't be turned down for pre-existing conditions anymore. No, really.

On all new plans, you are guaranteed acceptance even if you have a pre-existing condition or if you frequently use your health plan. No insurance company can drop you just because you get sick. You cannot be charged extra premium because you have a pre-existing condition. 

 

All plans cover Essential Health Benefits with no yearly or lifetime limits. 

Essential Health Benefits include doctor office visits, hospitalization, prescriptions, preventive care, and more. 

 

Is your family growing? 

All new plans must include coverage for maternity. If you're pregnant now, you cannot be turned down by any insurance company, and when the baby arrives, you'll get free well checkups and immunizations for your baby. 

 

Dental and vision care for children under age 19 is included now. 

Is your child overdue for a dental cleaning? Is she squinting to see the board at school? Good news! Dental and vision care for children are included in all new health plans. 

 

Young adults up to 26 can be covered on a parent's health insurance. 

ACA allows for children up to age 26 to be covered under a parent's health insurance plan. It does not matter if your children are married, students, or if you claim them as a dependent. They can be covered under your plan until they turn 26 - no questions asked. 

 

You'll get free well care. 

Health insurance isn't just for when you get sick; it's also for keeping you well so you don't get sick. All new plans include 100% coverage for preventive care - things like physicals, labs, screenings, pap smears, mammograms, PSA tests, colonoscopies, and more. Preventive care for children is included, too. 

 

 

 

THE POWER OF CHOICE

 

You can choose your insurance company.

Even if you accept a tax subsidy -  where the government helps pay your health insurance - you still have the power of choice. "Obamacare" plans are not issued by the government; instead, they're issued by brand-name insurance companies like BlueCross BlueShield, Humana, United Healthcare, and more.  Choose your favorite from the insurance companies available in your area.

 

You can also choose your benefits.

Whether you accept a tax subsidy or not, you'll be choosing from four categories of plans: Platinum, Gold, Silver, or Bronze.  And if you're under 30 or the other choices are unaffordable for you, you can also choose a "catastrophic plan" - where you'll pay more when you use your plan but pay less each month for the premium.

 

Use our Plan Guide to help you choose between Platinum, Gold, Silver, or Bronze. 

 

The benefits are the same, on or off exchange.

On-exchange plans are ones where you qualify for and accept government money to lower your costs. Off-exchange plans are ones where you don't. The law says that plans on and off exchange have to have identical benefits in your area, and the starting premium price can only vary +/- 2%. So if you accept a government subsidy, you are not giving up any benefits. 

 

Many on-exchange plans use a smaller doctor network, though. 

There's always a catch, isn't there? Even though the plan benefits are identical on or off-exchange, your doctor choices might be more limited with on-exchange plans. This isn't the case every time, so it's a good idea to check the provider network before enrolling in a plan.

 

Choose how you sign up.

There's many ways you can enroll in health plans, on or off-exchange. 1) You can enroll through the public exchange (government website) 2) You can enroll directly with the insurance company 3) You can enroll with a local agent 4) You can enroll through a private exchange (like us!). Choose the method that you feel the most comfortable with and enroll in the same plans for the same price.  

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