Let's go over how coverage works
How comfortable are you navigating Affordable Care Act (ACA) insurance ... or insurance at all?
No matter where you’re at, we’ve covered what you need to know for open enrollment on November 1.
Is ACA coverage right for you?
If you don’t have insurance through your job or a government program like Medicare, take a look at ACA plans. They’re available for almost everyone. And they can help you take care of your most important asset — you.
I work at a part-time job that doesn’t offer insurance.
You don’t need to work full-time to get ACA coverage. Your income may even qualify you for a premium discount and extra savings.
I lost my job and my health insurance coverage.
You’ve got options. One of them is COBRA. But this coverage typically runs out after 18 months, and it can be pricey. The good news is that ACA coverage typically costs less.
I run my own business, but I don’t have employees.
With ACA coverage, you can choose the premium and out-of-pocket costs that are right for you. You may even be able to deduct the premiums you paid on your income tax.
I’m a freelancer, gig worker or consultant.
With lots of ACA plan choices available, you get to choose what best fits you. And since you’re self-employed, you may even get a tax break on your premiums.
I work at a part-time job that offers insurance.
You can still buy an ACA plan. But if your employer’s plan meets certain affordability and quality standards, you may pay less for employer coverage than an ACA plan.
I’m retired, but not old enough for Medicare.
With ACA coverage, you’ll find many plan options and you may even qualify for financial help to lower your costs. Plus, everyone who applies can’t be denied coverage for preexisting conditions.
Let’s dig into ACA coverage
All ACA plans must cover 10 essential benefits like hospitalization, preventive care and mental health services. Some plans offer extras like dental and vision.
Every plan is assigned what is known as a metal tier: Platinum, Gold, Silver or Bronze. Metal tiers have nothing to do with the quality of care you receive. They determine how you and your plan split costs.
You can apply for ACA coverage and financial help through companies with direct enrollment sites, like us, or on the federal marketplace. If you shop off the marketplace, you won’t get financial help.
When you enroll in a plan on the marketplace, you may be eligible for discounts on your monthly bill or extra savings on your out-of-pocket medical costs.
The top insurance terms you'll want to know
Let's go over some common insurance terms you might see during your coverage search.
Copay
This is a fixed amount that you typically pay at the time you get care. For example, you might pay $40 when you see your doctor.
Deductible
This is the amount you pay before your plan starts to pay for some or all of your costs.
Coinsurance
This is a percentage that you pay after you’ve met your deductible. For example, if your plan covers 80% of the cost for physical therapy, you would pay the remaining 20%.
Out-of-pocket maximum
This is a cap on your plan costs. Once you have paid this amount through your deductible, copays and coinsurance, your plan pays 100% of all covered costs for the rest of the plan year.
Referral
This is an order from your provider, written on paper or sent electronically, to see another provider or for a specific health service.
Network
This is a group of providers — like doctors and clinics — that have a contract with a health plan. When you see a provider in your health plan’s network you get special, lower rates.
Save the date: ACA enrollment periods
When is the Open Enrollment Period?
The time to choose an ACA individual and family plan is right around the corner. The Open Enrollment Period for 2023 opens on November 1, 2022 and ends on January 15, 2023. Enroll by December 15, 2022 for coverage that starts January 1, 2023.
The Open Enrollment Period is the time of year when you can explore plan options, see if your doctor participates in the plan, apply for financial help and purchase health plan coverage. So you don’t want to miss out.
If I miss the deadline, can I still sign up for ACA coverage?
Life won’t wait for open enrollment. So certain life events — called qualifying events — let you sign up for coverage outside the typical open enrollment window.
What’s an example of a qualifying life event?
Maybe you no longer have health care coverage because you’ve lost your job. Or maybe you’re getting married or having a baby or moving to a new state. These life events — and others — all give you the right to sign up for a health plan outside the Open Enrollment Period as long as you do so no more than 60 days after the event.
Now that’s innovation
Innovation Health is transforming the health care journey. Through innovative programs, coordinated care, and remarkable access, our health plans are personalized to fit our members’ needs. Discover how we are helping members achieve their health ambitions right in their community.
