The Affordable Care Act (ACA) is a law that helps patients in many ways. Some of the benefits include:
Health Insurance Marketplaces can help you find the best health insurance plan for your needs and budget. All plans in Marketplaces offer comprehensive (complete) coverage, and allow you to compare available options, prices, and plans by filling out just one application. After you apply, you will learn whether you qualify for free or low-cost health care, such as Medicaid or the Children’s Health Insurance Program.
All health insurance plans in the Marketplaces are offered by private companies. Your state has the choice to host a Marketplace or to allow the United States Department of Health and Human Services to host it. Access the Marketplace in your state.
All plans offered are required to include at least 10 "essential health benefits." These benefits include:
These are the basic services that all plans are required to offer you. However, you can also choose a plan that offers additional services. Plans are available in four different categories based on how much you want to pay for your monthly premium. These levels are Bronze, Silver, Gold, and Platinum. The Platinum plan has the highest monthly premium, and the Bronze plan has the lowest monthly premium. Remember to keep in mind that the higher the monthly premium you pay, the lower your out-of-pocket costs will be for things like office visits or other medical services.
You cannot be denied health insurance coverage if you have a pre-existing health condition. A health insurance company also cannot charge you more or refuse to pay for treatments related to a pre-existing condition. Also, women do not have to pay higher costs than men for the same health insurance plan.
You may qualify for lower monthly premiums or lower out-of-pocket costs based on your income and your family size. If you qualify for lower premiums or out-of-pocket costs, those lower prices will be reflected when you review your insurance plan options. The application process will determine whether you qualify for lower costs or for free or low-cost care, such as Medicaid or the Children’s Health Insurance Program.
To enroll, go to the Marketplace application web page, create a personal account, fill out the application form, and you will be presented with various plans that meet your needs.
Note: Open enrollment ends March 31, 2014.
If you have health insurance through your employer, you can choose to keep your insurance or shop for a different plan in your state Marketplace. However, it is important to remember that your employer most likely pays part of your health insurance premiums, and if you decide to cancel your job-based health insurance, your employer is not required to help pay your premiums for a new plan that you pick through the Marketplaces.
If you don’t have health insurance, and you choose not to select a plan through the Marketplaces, you will be responsible for all your medical costs, including office visits, immunizations, prescription medicines, and major medical services such as surgery and hospitalization.
Also, beginning April 1, 2014, you will have to pay a fee for not having health insurance, and you will not be able to enroll for health insurance until the next annual enrollment period, unless you have a qualifying life event. Examples of qualifying events include moving to another state, getting married or divorced, having a baby, or changing income levels.
The following resources can help you learn more about the Marketplaces and your health insurance options.
Written by familydoctor.org editorial staff