ACA (ObamaCare) Alabama & Indiana Health Insurance Exchange Marketplace Options

Penalty Free Guaranteed Issue

The Affordable Care Act or ACA was passed into law by President Barack Obama. While the polices available through the ACA have continued to decline, they are still the only policies that cover pre-existing conditions from day 1 and have guaranteed acceptance. These policies are best suited for customers that want to avoid the ACA penalty (2.5% of income) and have chronic conditions covered. We can help you find the right ACA insurance policy for your situation.

So what exactly is the ACA and what does it mean for you? In the articles below I'll give you a brief overview of the ACA and how it may or may not affect Alabama or Indiana health insurance marketplace customers. These plans feature no pre-existing conditions and guaranteed acceptance. Also, some customers will qualify for special tax subsidies that will lower the overall cost of their plan. Affordable Care Act plans are available during annual open Obamacare enrollment periods and during special election periods, such as losing credible coverage in the last 60 days, marriage, divorce and certain other life-changing events.

Subsidies

Customers whose income is 138% to 400% of the federal poverty line can receive financial assistance known as subsidies each month that are applied to their monthly premium or taken as one lump sum payment at tax time. It's important to update the federal marketplace to any changes to income because this will affect subsidies and they may have to be repaid if the income reported is lower or higher than the actual income. Subsidies are reconciled at tax time and any repayment owed is added to your taxes due. On the other hand, if your income is lower than what you reported, you may receive additional subsidies at tax time. Unless it's under 138% of the FPL in which case you may lose all subsidies. For this reason, we recommend working with an agent.

Pre-Existing Conditions

Prior to the Affordable Care Act when a family or individual bought their own Indiana health ACA insurance coverage (non-employer provided) any conditions that they were already dealing with from small health issues to chronic health issues were not covered for at least a year. That all changed with ACA health insurance (also known as ObamaCare). With ObamaCare any conditions that you are currently being treated for are covered under your new plan, this includes medications. We can talk a lot about the negatives of the ACA, but for many people, this feature is clearly a positive feature. There is nothing special that needs to be done, in fact, the pre-existing condition doesn't even need to be mentioned on the application. You just apply for coverage and on your policy start date, all conditions are covered, as long as it's a medically covered condition (for example, breast implants would likely not be covered).

Types of Health Insurance Networks

You've likely heard of HMO plans or PPO plans and maybe even wondered what those three letters meant or stood for. Below we will break all of the common plan types down for you, so you no longer need to wonder and can decide on the right plan type for you or your family.

HSA

Health savings accounts and high deductible health insurance plans are a popular alternative to traditional Alabama or Indiana health insurance coverage. Typically, HSA'a are less expensive than traditional plans. Consumers who purchase this coverage will own a savings account they draw from for health-related expenses. Funds deposited into an HSA are tax deductible and will grow tax-deferred. When withdrawn for a qualified medical expense funds are spent tax-free. The accumulated funds always belong to the insured. If the owner discontinues their insurance plan, they keep the funds in their HSA for themselves. HSA qualified health plans typically do not offer doctor & Rx co-pays and do not start paying for services until the deductible on the plan is met.

PPO

A PPO or Preferred Provider Organization is the most popular type of plan available in the US market. With a PPO you can visit any provider you want and do it without first obtaining a referral from your primary doctor. However, if you choose to visit a doctor that does not have a contract with your ACA insurance company, you will pay more money out of your pocket then visiting a doctor that has contracted with your health insurance carrier. With most PPO plans if you visit a doctor that is in the carriers network you will only have to pay a set co-pay amount. This amount is typically between $10-45 and covers basic doctor's office services. Often times there is a lower co-pay amount for primary care visits and a higher co-pay amount to visit specialist.

HMO

An HMO or a Health Maintenance Organization is a plan that typically offers lower monthly premiums and lower out of pocket cost in exchange for less patient control and more physician control. When visiting a provider you must use a network provider (a doctor or facility that has contracted with the insurance company) and if visiting a specialist you need to get a referral from your primary provider (a family or internal doctor that serves as your main provider). Usually the only exception to this rule is if you are seeking emergency treatment, like an ER. Because everyone you are likely to visit already has a contract with the insurance company it's unlikely that you will need to fill out any claims paperwork since your doctor's office will do this for you as part of their agreement with the health insurance carrier.

POS

A POS or Point of Service plan is a sort of hybrid plan of a HMO and a PPO. Many times patients still need to select a primary care provider. However, the plan will help pay the cost of seeing an out of network provider, if their primary care provider made a referral to the provider that is out of network. However, cost sharing is still lower for the consumer when using a network provider over a non network provider. In most cases if care is received outside the plans network the patient will be responsible for filing the claims paperwork with their carrier and waiting for payment reimbursement from that carrier. Premium payments on POS plans usually fall between HMO and PPO plans. With HMO plans costing less and PPO plans costing as much as 50% more.

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ACA Insurance Coverage and Marketplace Plans Q&A

What is a Marketplace ACA plan? The Marketplace is the result of the Patient Protection and Affordable Care Act (ACA) signed into law on March 23rd 2010. In addition to requiring insurers to provide 10 essential benefits and other mandates, the law provided tax subsidies that help offset the cost of health insurance premiums to lower and middle income Americans. The Marketplace is the exchange created to enroll uninsured Americans in public plans that comply with the ACA and are eligible for subsidy payments. Families can enroll in a Marketplace plan on their own, with a Marketplace Navigator or with the assistance of a local health insurance agent like myself.

What is a Special Election Period or SEP?
A SEP is a special enrollment period outside of the normal ACA insurance
enrollment period of November 1st to December 15th every year. SEP status gives the health insurance applicant a period of time to purchase and enroll in Affordable Care Act compliant coverage. The period of time to enroll occurs within a 60 day time frame of a life changing event as defined by the Affordable Care Act. In most cases documentation is required to prove the life changing event has occurred, such as a letter from an employers HR department stating the employee has lost health insurance benefits. If you are working with a health insurance agent, the agent will likely take these documents and upload them directly to the federal Marketplace database. If applying on your own you will receive a letter with instructions on where to send the requested documents.

When can I buy or enroll in a Marketplace plan (ACA aka Obamacare)? Most people can enroll in Marketplace coverage from November 1st to December 15th every year. People who have had life changing events such as marriage, child birth, loss of other credible health insurance coverage and other qualifying events can enroll in Marketplace coverage within 60 days of the life changing event. This is known as a Special Election Period or SEP.

What is a healthcare subsidy? Subsidies are part of the Affordable Care Act. They provide lower and middle income Americans with a credit that they can choose to use monthly or annually when they file their taxes, to help offset the cost of individual health insurance premiums.

How much does a Marketplace plan (aka Obamacare) cost? Marketplace coverage uses a community pricing model for plan cost. Everyone your age that lives in your county should have the same plan cost for the exact same plan, regardless of health. However, based on your families adjusted gross income you may qualify for tax subsidies to help offset the cost of you plan. Those with incomes below 400% of the federal poverty line (FPL) and at least 100% of the FPL should qualify for help. The closer to 100% (or 138% in some states) the more subsidy dollars you can use to help pay for your coverage. You can find out how much subsidy you qualify for by visiting our ACA Marketplace quote engine.

Does Indiana have Obamacare? Yes. Indiana residents are eligible to enroll in Marketplace coverage through the federal ACA Exchange. Those with household incomes that are between 139 to 400% may be eligible for tax subsides. Those under 139% of the federal poverty line may qualify for the Healthy Indiana Plan (HIP).

Does Alabama have Obamacare? Yes. Alabama residents are eligible to enroll in Marketplace coverage through the federal Marketplace Exchange. Those with household incomes that are between 100 to 400% may be eligible for tax subsides. For those under 100% of the poverty line there are some patient assistance programs available on the Alabama state Medicaid website.

Are Health Savings Accounts available through the Marketplace exchange? Yes, the Marketplace plans available in most states feature a HSA eligible option. You'll want to already have or open a Health Savings Account at a bank so that you can take advantage of the annual HSA contributions for yourself or family.

Does it cost to use a health insurance agent? No, it does not cost any extra to use most independent health insurance agents. All insurance policy pricing as well as other rules and enforcement of insurance laws is overseen by each states insurance commissioner. Agent compensation is already included in the price or premium for the plan, regardless of whether you use an agent or not. While an agent could charge the consumer a fee for their service if agreed to by the client, very few do.

Do you charge a fee? No, we do not. With our best price guarantee we promise you won't find a better price on the same plan anywhere. You'll receive no cost help and the best possible price. Just visit our free health insurance quote page or schedule an appointment to meet face to face in your home or office to get started.

What is a health insurance deductible? The deductible is the amount that the insured must pay out of their own pocket (usually on a collective annual basis) before the insurer starts to pay. Some plans may pay small amounts for routine care like doctors visits before the insured has met his or her deductible. The purpose of the deductible is two fold, one it helps reduce the risk exposure for the insurance company. It's less money they have to pay out of their pockets. This is why higher deductible plans tend to have lower monthly premiums. The second reason is that it requires the insured to participate in their healthcare funding therefore reducing the likelihood that you will use emergency rooms and doctor's services without having a real need.

What is a health aca insurance co-pay? The copay is a set dollar amount that the insured must pay for routine care, like doctors visits and receiving medication. Co-pays often range in price from $5-60 and are usually paid to the provider at the time of the service. Often times these co-pay payments do not count towards a plans annual deductible amount.

What is health insurance co-insurance? Co-insurance is the amount that the insured is responsible for after the deductible is met. So if you have 70/30 co-insurance you will pay 30% of the bills until your max out of pocket (MOOP) is met.. After the MOOP is met the carrier will pay 100%.

What is Max Out of Pocket? The Max Out of Pocket is the most money an insured should pay out of their own pocket in a year (or term) before the insurance company is responsible for 100% of the medical bills.

What is a short term policy? A short term health policy is a plan that only exist for a short period of time, usually 6 or 12 months. At the end of the term period the insured can reapply and the insurance company can except or decline the applicant.

What is a network? A health insurance network is a group of doctor's, hospitals and other medical providers that have contracted with an insurance company to offer pre-negotiated rates for services provided to the insurers customers. Some plans like HMO's require that insureds use their network. Other plans offer lower co-pays to those who use their network.

I keep getting phone calls about insurance plans due to healthcare reform. Is this legit? This is a hard one. Of course it could be straight up rogue marketing, but If it’s someone trying to be honest with some changes, there have been a couple, although Republicans have not technically tied the change to “healthcare reform” 2 executive orders under the Trump administration could be seen as such. One is almost a couple years old now and that’s the executive order to not enforce the individual mandate. So now regardless of the plan you have, you can avoid the penalty for not having ACA compliant health coverage. The 2nd is a little newer and allows short term policies to start selling 1 year terms again. At the same time though Indiana had a law that restricted term plans to 6 months. This law was changed in July of 2019 to allow 1 year terms now. So for some people who wouldn’t have considered a term plan in the past (for the fear of not being approved at the end of the term, mid year), this may no longer be an issue. If you’re declined coverage at the end of your short term policy, we can switch you to a guaranteed acceptance ACA policy, so long as the term is set to end at the end of the year, during ACA Marketplace open enrollment.