Compare in Minutes
Top Carriers & Brokers
100% Safe & Secure
Compare in Minutes
Top Carriers & Brokers
100% Safe & Secure
Finding the right plan can be difficult. Each plan has its pros and cons, especially considering how costs can vary depending on the plan's monthly premiums, deductibles and co-pays. The good news is that ObamacarePlans.com summarizes all the key info for you. Read below to compare your options and decide.
What Are ACA Plans?
ACA plans are sometimes referred to as major medical, comprehensive coverage, or even “Obamacare” - these plans meet all the requirements of the ACA and are typically the most comprehensive on the market. ACA plans must include coverage for outpatient care, emergency care, hospital stays, mental health coverage, prescription drugs, rehab services, lab services, free preventive care, maternity and newborn care, and pediatric care, with no annual or lifetime coverage maximums. These plans are available to almost everyone, and you can’t be denied based on preexisting conditions.
ACA plans have different levels – bronze, silver, gold and platinum – all of these plans offer the same essential benefits. The difference between the metal levels is how much you pay out of pocket:
How Can I Purchase an ACA Plan?
You can purchase an ACA plan either through a Federal or state marketplace (or their authorized broker partners) or directly from an insurance company or broker. Purchasing through the government or state exchange site is known as buying "on-exchange." Purchasing directly through an insurer or broker is considered buying "off-exchange" or "outside the marketplace."
When Can I Enroll in an ACA Plan?
In most cases, you need to enroll in an ACA plan during the annual Open Enrollment Period, which runs from November 1 to January 15 in most states (some states have different dates).
After open enrollment ends, you can normally only enroll in an ACA plan if you have a “special enrollment period” triggered by a qualifying life event. Learn more about qualifying life events and special enrollment periods here.
Outside of the open enrollment or special enrollment periods, you may be able to purchase a non-ACA health plan, such as a short-term health insurance plan.
Is There Government Assistance To Help Me Pay For My Health Care?
To help make your health care more affordable, there are two forms of government assistance available if you the U.S. Government If you meet certain requirements, you may be eligible for a Premium Tax Credit from the U.S. Government to help reduce the monthly premiums for
If you find that an Affordable Care Act (ACA) plan is financially out of reach or if you've missed the enrollment deadline, you might want to explore the option of short-term health insurance plans. These short-term plans differ significantly from ACA coverage in that they generally offer more limited coverage, generally do not cover preexisting conditions, are subject to annual and lifetime benefit maximums, and do not exempt you from state tax penalties. However, they have the advantage of being available for application throughout the year, and can provide some financial relief in the event of unexpected medical events that are unrelated to a preexisting condition. It's essential to understand that short-term health plans do not adhere to ACA regulations, potentially leaving gaps in your healthcare coverage. Therefore, it's crucial to carefully review the plan's specifics before deciding to enroll. Additionally, keep in mind that purchasing short-term health insurance may render you ineligible for other health insurance options, including ACA plans and COBRA. This is an important consideration when weighing the pros and cons of short-term plans.
| This Insurance | Insurance on HealthCare.gov |
|---|---|
| May deny you coverage if you have a preexisting condition | You cannot be denied coverage because of a preexisting condition |
| There may be no limit to the amount you have to pay out-of-pocket for care | The most you have to pay out-of-pocket for essential health benefits in a year is limited |
| You will not qualify for Federal financial help to pay your premiums and out-of-pocket costs | You may qualify for Federal financial help to pay your premiums and out-of-pocket costs |
| You may not have access to all essential health benefits, including: pediatric, hospital, emergency, maternity, mental health, and substance use disorder services, prescription drugs, and preventative care | You will have access to all essential health benefits, including: pediatric, hospital, emergency, maternity, mental health, and substance use disorder services, prescription drugs, and preventative care |
Medical indemnity health insurance, often referred to as fee-for-service plans, operates by providing you with a predetermined amount for specific healthcare services, such as $50 for a doctor's visit. In this scenario, irrespective of the actual bill for the doctor's visit, the plan reimburses you with a fixed $50. When used in conjunction with other insurance coverage, medical indemnity plans can be beneficial in offsetting out-of-pocket medical expenses like copayments and coinsurance. You have the option to acquire a medical indemnity plan as your sole insurance or as part of a broader insurance package. However, similar to short-term health insurance, it's important to note that medical indemnity plans do not adhere to the Affordable Care Act (ACA) requirements and do not exempt you from state tax penalties. Additionally, they generally do not cover preexisting conditions and may impose per-incident, yearly, and/or lifetime benefit limits. It's essential to recognize that medical indemnity plans may not be suitable for everyone. However, if you're seeking assistance with covering medical costs and expenses, they could be a viable option to explore further.
Healthcare sharing ministries (HCSMs) are unique entities distinct from traditional health insurance. They are formed by members who share common ethical or religious beliefs and, in accordance with those beliefs, contribute a regular payment to collectively cover the qualifying medical expenses of the members. HCSMs have long been an alternative for certain religious communities that object to traditional insurance, as they allow members to share health care costs as a community.
It's important to note that while HCSMs may resemble traditional insurance products in some respects, they are not insurance, and because HCSMs are not required to comply with the ACA’s consumer protections, coverage for preexisting conditions may be limited or excluded, medical benefits are typically far more limited than in ACA-compliant plans, and members are never guaranteed payment, even for covered services. However, HCSMs typically have lower monthly membership dues compared with full-price health insurance premiums for individuals who do not qualify for the ACA's premium subsidies. The table below summarizes some of the key differences between HCSMs and ACA plans:
| Consumer Protection | ACA Plans | HCSMs |
|---|---|---|
| Includes coverage for preexisting conditions? | Yes | Not usually |
| Bans charging higher rates based on health status? | Yes | No. HCSMs may charge a higher rate based on health status and some will deny membership to those who can’t pass a medical screen |
| Covers all essential health benefits? | Yes | No |
| Covers benefits without dollar caps? | Yes | Not usually |
| Caps out-of-pocket expenses? | Yes | No. HCSMs often limit the amount members can share and members are responsible for bills exceeding that limit; no HCSM guarantees payment of medical bills. |
