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Finding the Right Plan for Each Individual and Family

ACA Open Enrollment: November 1, 2023 – January 15, 2024

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.

Need help comparing costs of plans in your area? Call our ACA experts: 888.995.1674

Health Coverage Resources

Tips to Help You Choose the Right ACA Health 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.

Are Your Providers in the Plan’s Network?

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.

What Will My Total Costs Be?

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.

  • Premiums are the amount you pay to the insurance company each month to be covered by the plan, whether or not you use medical and pharmacy services.
  • Deductibles are the costs you must pay for covered health services before your health plan pays anything. See if the plan has combined medical and pharmacy deductibles or if you have separate deductibles for each.
  • Co-insurance is the percentage of the costs you pay after your health plan has paid its share, and kicks in once you meet your deductible.
  • Copayments are the set amount you pay for healthcare visits, medicines, and supplies. For example, you may have a copayment of $20 for each doctor’s visit.

Are The Medicines I Take Covered by the 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.

What Metal Plan Offers the Best Value?

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.

You don't have to do this alone. Let our ACA experts help you find the perfect plan. CALL TODAY

Affordable Care Act

Affordable ACA Health Insurance

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:

  • $14,580 to $29,160 for an individual
  • $19,720 to $29,580 for a couple

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.

  • $29,161 to $58,320 for an individual
  • $39,441 to $78,880 for a couple

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.

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Affordable Care Act

What Will My ACA Health Plan Cover?

All ACA health plans cover 10 essential health benefits:

  1.  Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  2. Emergency services
  3. Hospitalization (like surgery and overnight stays)
  4. Pregnancy, maternity, and newborn care (both before and after birth)
  5. Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
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Affordable Care Act

Adult Dental and Vision Coverage

Dental and vision coverage are not considered essential health benefits for adults. Some plans do cover vision and dental care, so check your plan.

We Can Help you Enroll in a Dental or Vision Plan

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If You Have a Pre-existing Medical Condition

All ACA marketplace plans, unless grandfathered, must cover treatment for pre-existing medical conditions:

  • No ACA insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any conditions you had before your coverage started.
  • Once you’re enrolled, the plan can’t deny you coverage or raise your rates based only on your health.
  • If you’re pregnant, coverage starts the day your plan starts.

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.

Pre-existing mental and behavioral health conditions

  • Your ACA plan can’t deny you coverage or charge you more for any pre-existing condition, including mental health and substance use disorder conditions.
  • Coverage for treatment of all pre-existing conditions begins the day your coverage starts.
  • Your plan can’t put yearly or lifetime dollar limits on coverage of any essential health benefit, including mental health and substance use disorder services.
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Affordable Care Act

Pregnancy 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.

Birth Control

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.

Preventive Health Services

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:

All AdultsWomenChildren

Mental Health and Substance Abuse

Mental and behavioral health services are essential health benefits All plans must cover:

  • Behavioral health treatment, such as psychotherapy and counseling
  • Mental and behavioral health inpatient services
  • Substance use disorder (commonly known as substance abuse) treatment

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.

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