We help make health insurance easier.

At ePlatinumHealth, we understand it can be difficult to keep up with the health insurance industry.

From the Affordable Care Act (ACA) passed in 2010 to President Trump’s executive order in October 2017, our independent agents are well-versed in the changes to the market. We can help you understand the covered essential and additional benefits, as well as the rights and protections given to consumers under the ACA. We know that it can be difficult to compare plans to find what’s best for you, your family, and your budget. We will explain your options, answer your questions, and do everything in our power to make sure that you and your family have the coverage you need.

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UNDERSTANDING YOUR OPTIONS

The Affordable Care Act (ACA)

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What is the Affordable Care Act?

The Individual healthcare insurance market is known by a few different names: Major Medical Insurance, The Marketplace, Affordable Care Act, Obamacare, etc. All of these are in fact the same thing: a platform that facilitates the sale of private health insurance plans operated by the United States federal government under the Patient Protection and Affordable Care Act of 2013.

The Affordable Care Act (ACA) was passed in 2010 to expand the marketplace for healthcare in the United States, to protect insured individuals, and to lower the costs of healthcare. The ACA is a gigantic read, and learning the ins and outs of it is an immense undertaking. The ACA guarantees that certain essentials and additional benefits will be covered under all medical health insurance plans. It also provides a number of protections and rights for health insurance consumers.

More about ACA

Affordable Care Act 101

Under the Affordable Care Act all medical health insurance plans must cover a list of essential health benefits that includes:

  • Ambulatory patient services
  • Emergency services
  • Maternity, pregnancy, and newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventative and wellness services
  • Pediatric services

All plans must also include some additional benefits, including birth control coverage and breastfeeding coverage. Plans may provide other benefits such as dental and vision but are not required to.

The Affordable Care Act also introduced a number or rights and protections for healthcare consumers such as requiring insurance companies to cover people with pre-existing health conditions and making it illegal for insurance companies to cancel coverage for patients who become sick.

Who is eligible for the Affordable Care Act?

People who are not on an employer group insurance plan such as those who are self-employed, small business owners or students, and/or those who are not on Medicare.

What does the ACA cover?

All Marketplace plans cover the same 11 Essential Benefits:

  1. Preventative and wellness services, and chronic disease management
  2. Emergency services
  3. Ambulatory patient services (outpatient hospital care)
  4. Hospitalization (inpatient hospital care)
  5. Laboratory services
  6. Prescription drugs
  7. Birth control coverage
  8. Pregnancy, maternity, and newborn care, including breastfeeding coverage
  9. Pediatric services, including oral and vision care
  10. Mental health and substance abuse disorder services
  11. Rehabilitative and habilitative services and devices

These are the minimum coverage requirements for all plans; some plans may offer additional benefits such as adult dental and vision, and medical management programs for specific needs such as diabetes.

All Marketplace plans must also cover treatment for pre-existing medical conditions, and cannot reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started. After you are enrolled, your insurance carrier cannot deny you coverage or raise your rates based only on your health.

When can you enroll in ACA?
Each year there is an Open Enrollment Period during which you can apply for a new plan or change your current coverage; the Open Enrollment Period ends on December 15. To apply or change your plan outside the Open Enrollment Period you must have had one or more of the following Life Changes within the past 60 days to qualify for a Special Enrollment Period:
  • Changes in household
    • Such as marriage, birth/adoption of a child, divorce, or death
  • Changes in residence
    • Such as moving to a new zip code or county, moving to the U.S. from a foreign country, or moving to/from a shelter or transitional housing
  • Loss of health insurance
    • Such as losing employer group coverage, losing eligibility for Medicaid or CHIP, or losing coverage through a family member
  • Other qualifying reasons
Alternatives to ACA

There are two alternatives to traditional Marketplace plans: Health Sharing plans and Short-Term Major Medical plans.

Health Sharing plans are NOT insurance, strictly speaking, but do satisfy the ACA requirement. As a member of a Health Sharing plan you pay a monthly “contribution” instead of a premium. When you see your doctor, they will send the bill to the Health Sharing company who then pays the bill using money from a pool of every member’s contributions.

Short-Term Major Medical plans are designed to last no more than 90 consecutive days. They are helpful for providing coverage while someone is in between jobs, until someone becomes eligible for Medicare, or if someone missed the chance to enroll in an ACA plan. Some plans can be “stacked” to provide coverage longer than 90 days.

Does the ACA create insurance?

No, the ACA does not create new insurance policies. It is instead a law that regulates the insurance industry to provide affordable, accessible, and quality health insurance through private insurance to individuals. It also expands on existing public insurance, such as Medicare and Medicaid.

Do I have to have health insurance under the ACA?

The short answer here is yes. Under the ACA individual insurance is mandated, and you will have to be covered for at least 10 months of a year to avoid paying a penalty on your taxes. You may also qualify for exemptions from paying the penalty (which is monthly) for up to three consecutive months with a “coverage gap” exemption.

What does the ACA do for me?

The ACA has largely lowered the cost for health insurance plans, making them affordable for many people. It provides a range of protections and rights for consumers regarding what must be covered by insurance companies, increases in insurance rates, and choice of doctor. It allows young adults to remain on their parents’ plans until age 26. The ACA also makes certain demands of insurance providers, such as covering without increased charge those with pre-existing conditions, and making it illegal to cancel coverage for people who become ill.

Does the ACA require my employer to offer coverage?

That depends on the company for which you work. If your workplace employs over 50 people, then it is required to offer its employees health insurance benefits. If not, the ACA has opened up the marketplace to provide quality, affordable options for individuals.

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Let us help you navigate your options.

Contact an ePlatinumHealth Agent today!

Find an agent in your area and get in touch today to discover how we can help you find the right plan for your needs and budget.


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