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Our goal is to help find the right plan in your area and match you with a comprehensive $0 to Low Cost ACA health plan.
An ACA health plan, sometimes called a Qualified Health Plan or QHP, is a health plan that meets the requirements of the Affordable Care Act enacted in 2010. The ACA was intended to extend health coverage to millions of people more affordably than ever before, offering better benefits and lowering costs. Access was expanded through the creation of government health insurance marketplace exchanges where plans can be selected and compared. ACA plans are now offered through federal and some state health insurance exchanges for enrollment during an annual Open Enrollment Period or a Special Enrollment Period thereafter with qualified life event changes.
There are several key achievements featured in ACA plans:
Ultimately, the "best" ACA health plan for an individual will depend on factors such as their healthcare needs, budget, preferred providers, and eligibility for subsidies or other financial assistance. It's important for individuals to carefully compare plan options and consider their specific circumstances when selecting a health insurance plan.
The licensed agents at Engage Health Insurance LLC can help check eligibility, navigate the marketplace applications, and help select which plan is the most useable for an individual’s or family’s particular situation. We welcome your inquiry.
With a PPO, most healthcare is provided by a network of providers who are partnered with the plan and offer a substantial discount off their normal rates. Members can also receive service from providers outside of the network for a higher out-of-pocket cost. The major advantages of a PPO are flexibility and choice; for example, with a PPO you can get specialist visits covered without a referral from your primary care doctor.
HMOs are a lower cost alternative to PPOs, offering less flexibility but also lower premiums. Unlike a PPO, HMO members must receive care from doctors, specialists and hospitals that are within the HMO’s network. It generally won’t cover out-of-network care except in an emergency. An HMO may require that you live or work in its service area to be eligible for coverage. With an HMO, you select a primary care physician, or PCP, who serves as your primary contact for all of your healthcare needs. In addition to providing general medical care, your PCP must also be consulted in order to see a specialist. HMOs provide integrated care and focus on prevention and wellness.
An EPO health plan is a managed health insurance plan that requires you to see healthcare providers only within the EPO network. EPO plans won't usually pay for out-of-network care except in an emergency situation.
EPOs and HMOs are similar. The primary difference between an EPO and an HMO is that you do not typically have to have a primary care physician when you use an EPO. An EPO plan also typically has a larger network of providers than an HMO plan.
EPOs are similar to PPOs in that you don't usually have to get a referral to see a specialist. However, PPOs tend to be more flexible than EPOs and HMOs since they give you more options to go out of network.
With Point of Service plans, the subscriber is given a choice of receiving in-net work care or out of network care. With in-network care the insured receives care from a particular network of doctors and hospitals which is coordinated by the PCP or primary care provider. The PCP would provide a referral to see a specialist. Out-of-network coverage comes into play when the insured sees a provider who does not participate in the network and the care is not coordinated by the PCP. The insured pays more for out-of-network care than they would within the POS network.
Health Savings Account Plans allow you to put tax-free money away to cover healthcare costs. HSA Plans must be combined with a High Deductible Health Plan (HDHP), which is a plan that offers low premiums in exchange for a high deductible. HSAs and HDHPs complement each other because the income tax-free money that you put into your HSA can be used to pay for your deductible, should you ever require expensive medical care. HSAs are regulated by the IRS, and have similarities with other investment vehicles; for example, ownership can be transferred to a spouse tax-free if the account owner dies.
The licensed agents at Engage Health Insurance LLC can help you check your eligibility for a $0 or Low Premium Plan and help you navigate the enrollment process. Your inquiry is always welcome!
Absolutely, there are many trusted health insurance carriers to choose from in your area and around the country. It gets better every day. Some examples include;
The licensed agents at Engage Health Insurance LLC can help check eligibility, navigate the marketplace applications, and help select which plan is the most useable for an individual’s or family’s particular situation. We welcome your inquiry.
The health insurance marketplace classifies plans into four tiers named after the metals: Bronze, Silver, Gold and Platinum. These tier categories are based on how the insured and the plan split the costs of the health care.
Bronze: Plans have the lowest monthly premiums but you will pay more for most routine care yourself. The deductible or amount you pay before the plan starts paying is high and the copays are 40% when you receive services. Bronze plans are a good choice if you do not have chronic conditions and want coverage for emergencies. (A 60/40 plan)
Silver: Plans have a moderate monthly premium and moderate costs when you need care. Deductibles and coinsurance requirements are lower. You’ll pay 30% when you receive services. A silver plan can be cheaper than a bronze plan when you qualify for cost-sharing if eligible due to income below certain thresholds. You must pick a silver plan for those extra savings. This is a good choice if you quality for ‘extra-savings.’ Some ACA silver plans have 0% deductibles. (A 70/30 Plan)
Gold: Plans have higher monthly premiums and low costs when care is needed and low deductibles. With a gold plan you’ll pay 20% when services are used. Gold plans can be a good value if you need frequent care as though the monthly premium cold be more, nearly all other costs would be covered. (An 80/20 plan)
Platinum: Has the highest monthly premium but like the Gold plans could be a good choice if you use a lot of care. Deductibles are low and the coinsurance is 10% for services used. (A 90/10 plan)
Note: Plans in all of the metal tiers provide free preventative care, and many offer selected services for free or discounted prices where the deductible does not apply.
The licensed agents at Engage Health Insurance LLC can help you review the plans and choose one that fits your medical services needs. Many who qualify for an ACA subsidy due to income basis can get plans in various metal categories for $0 to very low monthly premium.
A Special Enrollment Period (SEP) provides an opportunity for individuals experiencing life changes to obtain or adjust their insurance coverage outside the regular open enrollment period. To be eligible for a Special Enrollment Period individuals must experience a qualifying life event. These events include, but are not limited to, getting married or divorced, having a baby or adopting a child, losing other health coverage (such as employer-sponsored coverage, Medicaid or losing coverage at age 26 coming off the parent’s plan), moving to a new area that affects eligibility for Marketplace coverage, gaining citizenship or experiencing certain changes in income that affect eligibility for premium tax credits or cost-sharing reductions.
The time frame for SEP enrollment is generally 60 days after the qualifying event. Some events, such as losing other coverage or gaining a dependent through birth or adoption, can trigger an SEP retroactively allowing enrollment in coverage back to the date of the qualifying event. Start dates are usually the 1st of the month following the enrollment date.
Documentation might be required to verify SEP eligibility such as a marriage or birth certificate or proof of income changes depending on the situation.
The licensed agents at Engage Health Insurance LLC can help check eligibility for the SEP and its triggering event. It is a complex landscape and we can help navigate the marketplace application, and help select which plan is the most advantageous for an individual’s or family’s particular situation. We welcome your inquiry.
Yes! The information on your health insurance application will be used from year to year to keep your coverage active. If you have any changes to your household or income information, it could affect your subsidy assistance and your monthly premium amount. Before the start of the new coverage year, the Marketplace will send you a notice explaining your current plan's renewal and any changes in costs or coverage for the upcoming year. Insurance companies may make changes to their plans each year, such as adjusting premiums, changing networks, modifying covered benefits or even not offering a re-enrollment Qualified Health Plan in the new plan year. It's essential to review this information carefully and update in order to actively address your new needs and options for coverage.
Marketplace auto-renewals will try and effect renewal into the closest plan based on the information in the previous year’s application. This is to ensure that current year enrollees who do not make an active selection by December 15th have a plan at the start of the year to avoid a coverage gap.
Active re-enrollment, where an applicant updates their application and plan selection, is always preferred to allow for the most accurate financial assistance eligibility determination. Engage Health Insurance LLC, with client auto-renewal permission will endeavor to renew into the closest plan for the same $0 or Low Premium amount with the same carrier so that coverage is not at risk. Your agent will review with you other selections as well.
Engage Health Insurance LLC is happy to help with an active selection during the renewal process in order to maintain your desired premium level and keep pace with your changing medical insurance needs.
Open Enrollment begins for health coverage for the next plan year. This is the first day consumers can enroll, re-enroll, renew or change health plans through the Health Insurance Marketplace or their licensed FFM/Exchange Certified Agent for coverage to start on January 1.
The last day to perform an active renewal of an existing plan before the Health Insurance Marketplace implements BAR auto-renewals intended to prevent coverage lapses so new plan year coverage is effective January 1st. Enrollments anytime in December will be effective January 1st. Active enrollments are encouraged so information is updated and any changes in circumstances or needs can be considered in new plan year choices.
New plan year coverage starts for those who enrolled in or changed plans by December 31 and paid their first premium or binder payment as required.
The last day of the Open Enrollment Period and the the last day to enroll in or change health plans for coverage that would become effective on February 1 without an SEP. Enrollments after January 15 until the end of January fall into a Special Enrollment Period but can be effective February 1.
Coverage effective date for consumers who enrolled in or changed plans after year’s end through the end of January and paid their first premium or binder payment as required.
The licensed agents at Engage Health Insurance LLC can help you check your eligibility for a $0 or Low Premium Plan and help you navigate the enrollment process. Your inquiry is always welcome!
Open enrollment for ACA (Affordable Care Act) health plans is a designated period during which individuals and families can enroll in, make changes, renew, or re-enroll in their health insurance coverage through the Health Insurance Marketplace. This is done on an annual schedule and allows individuals to sign up for a health insurance plan or switch to a different one which better meets their needs. This includes individuals seeking insurance for the first time as well as those renewing or changing plans.
Open enrollment is yearly with a start and end date which might vary slightly from year to year but generally is November 1 of a given year and runs until January 15th of the next year. The federal government and state-based exchanges announce these dates well in advance. Assuming enrollment by the end of December, the start date would be January 1st to be set for the new year.
A licensed FFM certified health insurance agent or agency such as Engage Health Insurance LLC can help you to navigate this process.
The licensed agents at Engage Health Insurance LLC can help you check your eligibility for a $0 or Low Premium Plan and help you navigate the enrollment process. Your inquiry is always welcome!
While you do not have to enroll through the Health Insurance Marketplace to obtain health insurance, if you are interested in an Advanced Premium Tax Credit, Subsidy and Financial Assistance to help pay for the plan, then it is best to utilize the marketplace exchange.
A licensed agent can help navigate the application for marketplace insurance. You will be prepared to answer questions related to zip code, family size, household income, and who in the household needs coverage. Once the information is entered an eligibility determination will be shown. You would have an idea then of what your subsidy might be and can review plans for the one that fits you best.
Some questions will be:
ACA plans through the health insurance marketplace are designed to be affordable and accessible for eligible individuals and families and to foster preventative care habits and wellness because it is accessible.
The licensed agents at Engage Health Insurance LLC can help you check your eligibility for a $0 or Low Premium Plan and help you navigate the enrollment process. Your inquiry is always welcome!
Absolutely! Subsidies or Premium Tax Credits are intended to subsidize the purchase of health plans offered through federal and state health insurance exchanges. The amount of the credit is dependent upon the income you report to the Health Insurance Marketplace on your application. The subsidies are designed to help individuals who might otherwise not be able to afford the protections of having health insurance to have access to many great plans.
Premium Tax Credits and Cost-Sharing Reductions are mechanisms for financial help depending upon your particular circumstances. An Advanced Premium Tax Credit (APTC) is a financial subsidy paid in advance by the federal government to the insurance company monthly to lower the monthly premium cost to you. If the subsidy is equal to or exceeds the plan premium, you may have $0 monthly premium result. Because these subsidies are based on your estimated annual income for the year, it is important to have an accurate estimate and to update the system with any changes. If your estimate is too low you may have to pay back some of the subsidy help received when the IRS reconciles the tax returns. Conversely, if the estimate was too high you could receive some additional subsidy in the form of a tax credit.
Cost-sharing Reductions are discounts that lower the Maximum Out-of-Pocket that you might pay under a health insurance plan. This can include “extra savings’ on deductibles and copayments. This type of cost reduction does not have to be reconciled at the end of the year as they are discounts and not tax credits. CSR’s are a feature of the Silver plans only.
The licensed agents at Engage Health Insurance LLC can help you check your eligibility for a $0 or Low Premium Plan and help you navigate the enrollment process. Your inquiry is always welcome!
Our goal is to help find the right plan in your area and match you with a comprehensive $0 to Low Cost ACA health plan.