Individual & Family
At ePlatinum Health we understand that it can be difficult to keep up with the health insurance industry. From the Affordable Care Act (ACA) passed in 2010 to President Trump’s executive order in October 2017, our independent agents are well-versed in the changes to the market. We can help you understand the covered essential and additional benefits, as well as the rights and protections given to consumers under the ACA. We know that it can be difficult to compare plans to find what’s best for you, your family, and your budget. We will explain your options, answer your questions, and do everything in our power to make sure that you and your family have the coverage you need.
Affordable Care Act (ACA)
The Affordable Care Act (ACA) was passed in 2010 to expand the marketplace for healthcare in the United States, to protect insured individuals, and to lower the costs of healthcare. The ACA is a gigantic read, and learning the ins and outs of it is an immense undertaking. The ACA guarantees that certain essentials and additional benefits will be covered under all medical health insurance plans. It also provides a number of protections and rights for health insurance consumers.
Under the Affordable Care Act all medical health insurance plans must cover a list of essential health benefits that includes:
- Ambulatory patient services
- Emergency services
- Maternity, pregnancy, and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventative and wellness services
- Pediatric services
All plans must also include some additional benefits, including birth control coverage and breastfeeding coverage. Plans may provide other benefits such as dental and vision but are not required to.
The Affordable Care Act also introduced a number or rights and protections for healthcare consumers such as requiring insurance companies to cover people with pre-existing health conditions and making it illegal for insurance companies to cancel coverage for patients who become sick.
ALTERNATIVES TO ACA
There are two alternatives to traditional Marketplace plans: Health Sharing plans and Short-Term Major Medical plans.
Health Sharing plans are NOT insurance, strictly speaking, but do satisfy the ACA requirement. As a member of a Health Sharing plan you pay a monthly “contribution” instead of a premium. When you see your doctor, they will send the bill to the Health Sharing company who then pays the bill using money from a pool of every member’s contributions.
Short-Term Major Medical plans are designed to last no more than 90 consecutive days. They are helpful for providing coverage while someone is in between jobs, until someone becomes eligible for Medicare, or if someone missed the chance to enroll in an ACA plan. Some plans can be “stacked” to provide coverage longer than 90 days.
At ePlatinum Health we understand that navigating the world of health insurance can seem overwhelming, but we want to make it easier. If you have any questions, please do not hesitate to contact us. We will be happy to address any questions or concerns.
Below find some common questions and answers to them.
No, the ACA does not create new insurance policies. It is instead a law that regulates the insurance industry to provide affordable, accessible, and quality health insurance through private insurance to individuals. It also expands on existing public insurance, such as Medicare and Medicaid.
The short answer here is yes. Under the ACA individual insurance is mandated, and you will have to be covered for at least 10 months of a year to avoid paying a penalty on your taxes. You may also qualify for exemptions from paying the penalty (which is monthly) for up to three consecutive months with a “coverage gap” exemption.
The ACA has largely lowered the cost for health insurance plans, making them affordable for many people. It provides a range of protections and rights for consumers regarding what must be covered by insurance companies, increases in insurance rates, and choice of doctor. It allows young adults to remain on their parents’ plans until age 26. The ACA also makes certain demands of insurance providers, such as covering without increased charge those with pre-existing conditions, and making it illegal to cancel coverage for people who become ill.
That depends on the company for which you work. If your workplace employs over 50 people, then it is required to offer its employees health insurance benefits. If not, the ACA has opened up the marketplace to provide quality, affordable options for individuals.
Yes. There are two alternatives to the ACA Marketplace: Health Sharing plans and Short-Term Major Medical plans.