Got Questions?

• What type of affordable health plan options can I find?

• You can find various health insurance plans, including:

  • Affordable Care Act (ACA) Plans – Also known as Obamacare plans, these are comprehensive plans that cover essential health benefits and may offer subsidies based on income.
  • Affordable Care Act (ACA) Plans – Also known as Obamacare plans, these are comprehensive plans that cover essential health benefits and may offer subsidies based on income.
  • Fixed Indemnity Plans – Provide set cash payouts for specific medical services, but do not cover all healthcare costs.
  • Community/Cost Sharing Plans – Faith-based or membership-based programs where members share medical costs.
  • Private Health Insurance Plans – Non-ACA plans offered by private insurers, which can provide customized coverage based on individual needs.
• What are Affordable Care Act (ACA) Plans?

• ACA plans are health insurance policies that comply with the Affordable Care Act, ensuring coverage for essential health benefits like preventive care, hospitalization, prescriptions, and more. These plans cannot deny coverage based on pre-existing conditions and may offer premium subsidies based on income.

• What are Short-Term Insurance Plans?

• Short-term plans provide temporary health coverage, typically lasting from one month to a year. They are designed for those in between jobs, waiting for employer coverage, or needing a quick insurance solution. However, they may not cover pre-existing conditions, preventive care, or essential health benefits.

• What are Fixed Indemnity Plans?

• Fixed indemnity plans pay a predetermined amount for specific medical services (e.g., $100 for a doctor’s visit, $500 for hospitalization). These plans do not function like traditional health insurance and do not cover all medical expenses, making them best suited as supplemental coverage.

• What are Community/Cost Sharing Plans?

• These are non-insurance alternatives where members contribute to a shared pool of funds to help cover each other’s medical expenses. These plans often have faith-based requirements and do not guarantee coverage for all medical needs.

• How do I know if I qualify for ACA subsidies?

• Eligibility for ACA subsidies depends on household income and size. Generally, if your income falls between 100% and 400% of the Federal Poverty Level (FPL), you may qualify for premium tax credits to reduce your monthly insurance cost.

• What’s the difference between ACA and Private Health Insurance?
• • ACA Plans: Government-regulated, cover essential health benefits, and provide subsidies based on income.
  • Private Health Insurance: Can include non-ACA plans, often offering more flexibility but without government subsidies.
• Can I get coverage if I have pre-existing conditions

• Yes, ACA plans must cover pre-existing conditions without higher premiums. However, short-term and other private plans may not cover them.

• When can I enroll in an ACA health plan?

• ACA plans have an Open Enrollment Period each year (typically from November 1 to January 15). However, you may qualify for a Special Enrollment Period (SEP) if you experience life changes like job loss, marriage, or having a baby.

• Can I enroll in a health insurance plan outside of the Open Enrollment Period?

• Yes, but only if you qualify for a Special Enrollment Period (SEP) or if you choose a short-term, private, or cost-sharing plan, which can be purchased year-round.

• What should I ask my agent when speaking to them on the phone to ensure I get the right plan?

• To ensure you choose the best plan, ask the following:

  • What’s covered under this plan?
  • Are my doctors and hospitals in-network?
  • What are the out-of-pocket costs (deductible, copay, coinsurance)?
  • Does this plan cover my prescriptions?
  • Are there any exclusions or waiting periods?
  • Can I use this plan outside of my state?
  • Am I eligible for any subsidies or discounts?
• How do deductibles, copays, and coinsurance work?
• • Deductible: The amount you pay before insurance starts covering expenses.
  • Copay: A fixed amount you pay per visit or service (e.g., $30 for a doctor visit).
  • Coinsurance: A percentage you pay after meeting your deductible (e.g., 20% of a hospital bill).
• What happens if I don’t have health insurance?

• While there’s no longer a federal penalty for not having insurance, some states still require coverage. Additionally, going uninsured can lead to high out-of-pocket medical costs.