Affordable Care Act Plans (ACA)
The Affordable Care Act of 2010 is the official name of the federal statute that was signed into law in 2010 and came into force in 2014. The statute is commonly known as Obamacare, though many people have confused that term with the actual insurance plans that are available on the Federal Marketplace. ACA plans are provided by independent insurance carriers and not the government itself. However, the term Obamacare for the general public has eventually become synonymous with the insurance plans available on the Marketplace.
ACA plans are mandated by law to provide Minimum Essential Coverage (MEC) and cover the following 10 Essential Health Benefits:
- Hospitalizations
- Emergency services
- Ambulatory / Outpatient services
- Mental health care
- Prescription medications
- Pregnancy, maternity, and newborn care
- Laboratory services
- Preventive care, wellness services, and chronic disease management
- Pediatric services including dental and vision care *(adult dental and vision are not essential health benefits)
- Rehabilitative services and devices
ACA plans are also “guaranteed issue” which means insurers cannot deny coverage or charge higher premiums for pre-existing conditions. Insurers also cannot charge more premium based on gender. The three factors that are used to determine rates are the person’s age, whether they are a smoker or non-smoker, and the community rating for the county that they live in. No other factors are used in determine the insurance rates, though there are certain subsidies that eligible households can receive to lower their premium, which is explained further in this section.
The Affordable Care Act was written so that it provides federal subsidies towards premiums purchased through the Federal Marketplace for eligible recipients. Households whose income is between 100% and 400% of the Federal Poverty Level (FPL) are generally eligible to receive those subsidies known as Advanced Premium Tax Credits (APTC). APTCs are essentially tax credits that are advanced to the insurance provider on behalf of the insured individual/family. For example, a household of 4 may have selected a plan that has a $750 monthly premium yet based on their income that household may be eligible for a $600 monthly APTC. That $600 credit would then be advanced to the insurer each month to be applied to the full monthly premium, leaving only $150 of monthly premium that the insured would be responsible.
Health Plans of Texas will complete the application for your household with all the pertinent income information and obtain eligibility results for you directly from the Marketplace. Not all households are eligible for subsidy, but we will ensure that the eligibility results received are as accurate as possible to make sure no eligible individuals and households are left out. Our agents have been certified to assist people correctly complete the application and help them choose the right plan, since the inception of the ACA in 2014. We have the experience that many agencies and independent brokers lack.
The enrollment period for ACA plans is from November 1st through December 15th of each year. No enrollments can be made outside of this period unless the person qualifies for a Special Enrollment Period due to life event, such as losing employer coverage, getting married, or having a baby. If you believe your current situation may warrant a Special Enrollment Period or if you have doubts as to whether you are eligible, please do not hesitate to give us a call. We will help you determine if you are eligible for the Special Enrollment Period.
Health Plans of Texas works with all carriers providing ACA Marketplace plans in Texas, including:
BlueCross BlueShield of Texas
Ambetter from Superior Health
Molina Healthcare
Oscar Health
Friday Health Plans
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