Find Health Insurance with the Affordable Care Act
You have likely heard a lot about the Affordable Care Act (ACA), but if you still have questions about how it all works, here is a basic overview.
What is the Affordable Care Act?
The ACA aims to provide all Americans with access to health coverage. A large portion of the law is dedicated to establishing health insurance marketplaces — found at www.Healthcare.gov — through which Americans can shop for insurance.
As of 2019 (with tax filings in 2020), there no longer will be a penalty for not having insurance. However, be careful about skimping on coverage. Not only does health insurance save you on large, unexpected medical expenses — consider $30,000 for a three-day hospital stay or hundreds of thousands of dollars for cancer treatment — but plans under the ACA are required to cover preventative screenings and immunizations at no cost to you.
Of course, if you have a health insurance policy through your employer, or if you qualify for Medicare or Medicaid, you have nothing to worry about. However, if you’re one of 48 million uninsured Americans and you don’t qualify for government assistance, start with these steps to get insured.
Do Your Research
As a general rule, insurance plans with more options will cost you more than those with fewer. You should take into consideration your health needs, as well as your personal preferences when it comes to how you receive care, when choosing a plan. Here are a few basic descriptions:
- Health Maintenance Organizations (HMOs) tend to be less expensive, but more restrictive in terms of where you can go for treatment and require referrals from a primary care physician in order to see specialists.
- Preferred Provider Organizations (PPOs) typically cost more than HMOs, but offer more variety in the choice of physicians and allow you to see a specialist without a referral.
- Exclusive Provider Organizations (EPOs) offer lower premiums and eliminate the middle man if you want to see a specialist, but require you to use in-network physicians.
- Health Savings Accounts (HSAs) are savings accounts where you can put tax-free money to be spent on health-related expenses. You can’t have an HSA without having an insurance plan.
Get to Know the ACA Plan Types
ACA plans are divided into four tiers: Bronze, Silver, Gold and Platinum. There are also Catastrophic plans, which cover only accidents and extreme illness and only are available to people under 30 years old or to those who qualify for hardship exemptions.
All plan types provide the same essential health benefits, but they differ in terms of out-of-pocket costs.
Bronze plans have the lowest premiums, but high costs when you access care. Platinum plans, conversely, have the highest premiums, but the cost of accessing care is lower.
“Premium assistance” is a fancy way of saying “discount” on your monthly insurance payments. The amount of your premium assistance will be dependent on your family income for the year.
Get In-Person Help if You Need It
Free, one-on-one help is available from ACA navigators. They can answer questions, help you with completing an application, and guide you through the process. Local insurance agents can also help, but may not be as unbiased as the ACA navigators.
If you prefer, you can also sign up for health insurance under the ACA by phone or by regular mail.
[Any reference to a specific company, commercial product, process or service does not constitute or imply an endorsement or recommendation by National Endowment for Financial Education.]