Searching for ACA/Obamacare plans that provides free preventive health care and gives coverage for any pre-existing conditions you or your family may have? We’ll guide you through understanding any subsidies and plans that are available to best meet your needs through the Exchanges.
Most people qualify for lower costs on Marketplace plans through a premium tax credit or subsidy, so you will know your lowest price Exchange options.
All plans on the Exchanges are required to contain certain standards of benefit coverage, so any plan chosen will meet those minimums as determined by the Affordable Care Act.
Purchasing health insurance on the Marketplace is only available during Open Enrollment, which is Nov. 1 – Jan. 15 in most states. You may qualify for a special enrollment period due to a qualifying life event.
The marketplace offers individual health plans with coverage similar to employer insurance, including preventive care, doctor visits, prescriptions, and more. Plans come in different types (HMO, EPO, PPO, POS).
You and your Champion Benefit Advisors agent can explore where you might save on Marketplace premiums based on your location, household income and family size. Once you determine what will best meet your needs, your agent will ask you a few questions and enroll you.
You will pay your monthly premiums directly to the insurance company underwriting your plan.
All claims will be filed and paid through that insurance company for reimbursement.
HMO insurance has strict provider networks and only covers care received by in-network providers—unless you have an emergency. HMOs also require you to get primary care provider referrals to see specialists. These plans may be more affordable than other types of plans.
PPO insurance plans offer the most flexibility of the plan types. You don’t need to stay in the network, though out-of-network care generally costs more than in-network care. You also don’t need referrals if you want to see a specialist. PPOs cost more than HMOs and EPOs.
EPO insurance plans are similar to HMOs. Members have to stay within a plan’s network to get care covered. But you don’t need a referral from your primary care doctor to see a specialist if you have an EPO.
POS insurance plans are a hybrid plan combining aspects of HMOs and PPOs. POS plans cover out-of-network care, which makes them similar to a PPO but requires you to name a primary care provider to oversee your care and mandates referrals to see specialists, which makes them like an HMO. POS plans comprise only a small percentage of health plans, so this plan type might not be available in your area.
Our agents simplify the process and put your needs first so you can make well-informed health insurance decisions.
November 14, 2024
Our agents created this checklist to make sure you’re ready for the upcoming open enrollment period.
October 18, 2024
Supplemental plans help with high out-of-pocket expenses and provide tailored coverage your ACA plan might not have.
October 18, 2024
of Americans say there is someone in their household with a pre-existing health condition.
Nationwide, 44% of consumers selected a plan for $10 or less per month after the advance premium tax credit.
of ACA Marketplace enrollees received financial help through premium tax credits in 2024.
In 2024 there were a 21.4 million individuals enrolled for ACA Health Insurance, a 30% increase compared to 2023.
*According to Dept. Health and Human Services, Centers for Medicare & Medicaid Services,KFF, and CBPP
Connect with our agents who can answer your questions.
The ACA Marketplace makes quality health insurance accessible and affordable. Here’s a breakdown of the essential health benefits typically covered by Marketplace plans, ensuring you get the comprehensive coverage you need without breaking the bank:
The types of coverage are designated by metal: Bronze, Silver, Gold and Platinum and defined by differences in premiums and out-of-pocket costs such as deductibles, coinsurance and out-of-pocket maximums.
If you don’t expect to visit the doctor regularly and don’t have any ongoing prescription costs, this tier may work for you. This level will have the lowest monthly premiums, but also have the highest costs when you need care. The deductibles, which are the costs you are responsible for paying before your insurance plan will start to pay, can be thousands of dollars a year. These plans are recommended if you are looking for a low-cost way to protect yourself in a worst-case medical scenario, like a critical illness or accident.
Silver tier plans have a more moderate monthly premium and will cover more of your medical expenses when you need it. The deductibles for Silver plans are lower than Bronze. Silver plans are also used when you qualify for additional savings through cost-sharing reductions. This could save you thousands of dollars each year if you go to the doctor regularly.
This tier has a high monthly premium, but much lower costs when you need care. The deductibles will be lower on Gold plans as well, so if you go to the doctor more frequently, this may be a good plan for you.
The Platinum plans have the highest monthly premiums, but the lowest out-of-pocket costs when you need medical care. Deductibles are very low, which allows you to use your medical care more often, knowing nearly all your costs will be covered.
You don’t have to buy health insurance through the Exchanges or Marketplace. Many people have access to coverage through their employer. Champion Benefit Advisors can help you look at all your options, including Marketplace health insurance plans and consult with you on the most affordable health solution for your needs.
All plans on the Exchanges have deductibles, which is the amount you pay for covered health care services before your insurance plan starts to pay. These plans will also have copayments, which is a fixed dollar amount you pay for a covered health care service after you’ve paid your deductible. And Marketplace plans will also have other out-of-pocket costs that may be needed if you use services not covered. Some preventive services are free and some plans will cover other services without any additional costs.
To qualify for a plan on the Marketplace, you need to:
Enrollment happens annually: Normally, you can shop for plans during Open Enrollment, from November 1st to January 15th. This is the main window to get coverage for the next year.
But there are exceptions! You might qualify for a Special Enrollment Period if you experience life changes like:
These events can open a special window to enroll in a plan outside of Open Enrollment.
Generally, no. Unless you qualify for a Special Enrollment Period due to a life event, you’ll have to wait until the next Open Enrollment to change plans.
The start date depends on when you enroll. Generally, coverage begins the following month if you enroll by the 15th of the prior month.