ACA 101

1. What is an ACA plan?

Q: What is an ACA plan?
A: An ACA plan is a health insurance plan that meets the standards set by the Affordable Care Act. These plans are available through the Health Insurance Marketplace and must cover essential health benefits like preventive care, hospitalization, and prescription drugs.

2. Who qualifies for an ACA plan?

Q: Who is eligible for an ACA plan?
A: Anyone who is a U.S. citizen or legal resident and doesn’t have access to other affordable health insurance options (such as through an employer or government programs like Medicaid) is eligible for an ACA plan.

3. What is the Health Insurance Marketplace?

Q: What is the Health Insurance Marketplace?
A: The Health Insurance Marketplace is a service where people can shop for and enroll in affordable health insurance. The Marketplace is run by either the federal government or individual states, and it offers ACA-compliant health plans.

4. Do ACA plans cover pre-existing conditions?

Q: Are pre-existing conditions covered by ACA plans?
A: Yes, ACA plans must cover pre-existing conditions. Insurers cannot deny coverage or charge higher premiums based on your health history.

5. What essential benefits are included in ACA plans?

Q: What benefits do ACA plans provide?
A: ACA plans must cover essential health benefits, including preventive care, maternity and newborn care, mental health services, prescription drugs, emergency services, hospitalization, lab services, and pediatric care.

6. How much do ACA plans cost?

Q: How much will an ACA plan cost?
A: The cost of an ACA plan depends on factors such as income, household size, the plan’s coverage level, and where you live. Many individuals may qualify for subsidies (premium tax credits) to help lower costs, based on their income.

7. What are the metal tiers of ACA plans?

Q: What do the metal tiers of ACA plans mean?
A: ACA plans are categorized into four metal tiers: Bronze, Silver, Gold, and Platinum. These tiers represent how much the plan will pay for covered health care expenses. Bronze plans have the lowest premiums but higher out-of-pocket costs, while Platinum plans have higher premiums but lower out-of-pocket costs.

8. Can I apply for an ACA plan anytime?

Q: Can I sign up for an ACA plan anytime during the year?
A: No, you can only apply for an ACA plan during the Open Enrollment Period, unless you qualify for a Special Enrollment Period due to life events like marriage, childbirth, or losing other health coverage.

9. What is the difference between an ACA plan and Medicaid?

Q: How are ACA plans different from Medicaid?
A: ACA plans are designed for people who don’t qualify for Medicaid or other government programs and can pay for their own health insurance, whereas Medicaid is a state and federal program for low-income individuals. Some people may qualify for both, in which case Medicaid provides additional assistance.

10. Can I keep my doctor with an ACA plan?

Q: Can I keep my doctor if I enroll in an ACA plan?
A: It depends on the plan. Some ACA plans have provider networks, which means you may need to use doctors who are part of that network. However, many plans offer flexibility, and some allow you to choose any doctor or specialist who accepts the insurance.