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Health Insurance
Health Insurance 101
Marketplace Coverage
ACA Marketplace insurance, created under the Affordable Care Act, offers health plans that individuals and families can purchase through Healthcare.gov or state exchanges. These plans must cover essential health benefits, including doctor visits, prescriptions, hospital care, and preventive services. Depending on income, many people qualify for subsidies that lower monthly premiums and out-of-pocket costs, making coverage more affordable.
ACA Alternatives
Some off-Marketplace ACA alternatives include private health insurance plans that meet ACA requirements but are purchased directly from carriers instead of Healthcare.gov. These plans often offer broader PPO networks, giving people more flexibility in choosing doctors and hospitals. They can be a good fit for those who don’t qualify for subsidies and want nationwide or out-of-state coverage options.
I can help. I’ll guide you through the confusing path of Medicare, so you get the benefits you deserve.
Frequently Asked Questions
How do I know if I qualify for a subsidy to lower my premium costs?
Subsidies are based on your household income and family size compared to the federal poverty level. Most people qualify if their income is between 100%–400% of that level, though some states have expanded options. You can check eligibility instantly when applying through Healthcare.gov or your state exchange.
What is the difference between Bronze, Silver, Gold, and Platinum ACA plans?
These “metal tiers” reflect how costs are split between you and the insurance company. Bronze plans have the lowest premiums but the highest out-of-pocket costs, while Platinum plans have higher premiums but the lowest out-of-pocket expenses. Silver plans are the only tier that qualifies for additional cost-sharing reductions if your income is within certain limits.
Can I enroll in ACA insurance outside of Open Enrollment?
Yes, but only if you qualify for a Special Enrollment Period (SEP). This is triggered by certain life events such as losing other coverage, moving, getting married, or having a baby. Without a qualifying event, you must wait until the next Open Enrollment period.
What’s the difference between Marketplace and off-Marketplace ACA plans?
Marketplace plans are purchased through Healthcare.gov or state exchanges and may qualify you for subsidies. Off-Marketplace plans are bought directly from insurers and don’t include subsidies but can sometimes offer more network options like PPOs. Both types must still follow ACA rules and cover essential health benefits
Contact
Need more assistance?
Please contact Richard (Ric) Mora
CA Insurance License # 0B89517
[email protected]
(760) 678-8950
