Affordable Care Act FAQ’s

 


What type of plans are offered through the affordable care act?

The Affordable Care Act offers plans that are metal tiered based. Meaning that there are bronze, silver, gold and platinum plans. The higher the metal is worth the more expensive the plan costs but the copays are lower. There are both HMO, PPO and HSA type plans.

HMO-Health Maintenance Organization or managed care-You must use their Doctors and facilities and get a referral from your primary care physician to see a specialist.

PPO-Preferred Provider Organization-You can see anyone in the network without a referral. There is also a way to use non-network Doctors and faculties but you pay a high price to go out of network.

HSA-Health Savings Account-a plan that allows you to put away money pre-tax to pay for out of pocket medical expenses with pre-tax dollars. These plans have no fixed copays but you pay the contracted rates that the insurance company has with those providers. These plans are typically bronze plans.

On the Exchange-The affordable care act setup up exchanges where you can buy your insurance and if you qualify, get a subsidy to help pay for the insurance. These subsidies are based on income and the number of people in your family. (A separate chart is available to show those that qualify based on income.)

Cost Sharing Reduction-CSR is a reduction of the fixed co-pays available to those within certain income brackets in addition to the subsidy. (See separate chart)

Off the Exchange-Plans that do not offer subsidies can be bought through a broker or directly from the insurance company. You don’t pay an additional cost to use a broker and the plans premiums are the same.

When can I buy coverage?-You can buy coverage on or off the exchange during the annual open enrollment period which is currently from November 1st through January 31st. Under certain conditions you can buy plans at any time. Those conditions are what is known as Qualifying Life Events (QLE’s). They are very specific and are listed below.

         QLE’S-Marriage, divorce, death of spouse, birth, adoption, moving out of service area, loss of coverage, loss of Medicaid eligibility, loss of Medicare under certain circumstances

Nevada only-Can obtain insurance coverage without a qualifying life event with a 90 day waiting period. Not available in any other state

Essential Benefits-All ACA plans have to offer the same essential benefits. (See separate chart)


 

 

 

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