Affordable Care Act Plan

Understanding the Affordable Care Act

Navigating health insurance can be complex, but the Affordable Care Act Plan (ACA), commonly known as Obamacare, was designed to make healthcare more accessible and affordable for Americans. At Medinsco, we aim to simplify your understanding of the ACA and help you find the right health insurance plan for you and your family.

What is the Affordable Care Act (ACA)?

The ACA was enacted in 2010 with the primary goal of expanding health insurance coverage to millions of uninsured Americans, improving the quality of care, and reducing healthcare costs. It provides a framework for affordable, comprehensive health insurance plans available through the Health Insurance Marketplace.

Key Features of the ACA

All ACA plans must cover a core set of health services, including:

Essential Health Benefits:

All ACA plans must cover a core set of health services, including:

  • Preventive services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Pediatric services, including dental and vision care

Under the ACA, insurance companies cannot deny coverage or charge higher premiums due to pre-existing conditions. This ensures that everyone, regardless of their health history, has access to affordable healthcare.

To make health insurance more affordable, the ACA offers financial assistance in the form of subsidies and tax credits based on your income and family size. These subsidies/tax credits is the reason what makes the plans through ACA more affordable and some times even free. 

ACA Plans: SHOP vs. Individual

SHOP

(Small Business Health Options Program)
  • Designed for small businesses with 1-50 employees.
  • Provides options for businesses to offer health insurance to their employees.
  • Employers may qualify for a tax credit to help cover the cost of providing health insurance.

Individual Plans:

 
  • Available to individuals and families who do not receive health insurance through an employer.
  • Plans can be purchased through the Health Insurance Marketplace.
  • Financial assistance may be available to help reduce premiums and out-of-pocket costs.

Determining Your Eligibility

Family Size and Income:

  • Your eligibility for ACA plans and subsidies depends on your household size and income.
  • The Health Insurance Marketplace uses the Federal Poverty Level (FPL) to determine eligibility for subsidies.
  • If you have access to health coverage through an employer sponsored plan or through Medicaid, you will not qualify for a subsidy/tax credit. 

Income-Based Subsidy:

  • Subsidies are available to individuals and families with incomes between 100% and 400% of the FPL.
  • These subsidies can significantly lower your monthly premium costs and out-of-pocket expenses.

Government Subsidy:

  • The ACA provides two main types of financial assistance: Premium Tax Credits and Cost-Sharing Reductions.
  • Premium Tax Credits: Help lower your monthly insurance premiums. The amount of the credit is based on your estimated annual income and household size.
  • Cost-Sharing Reductions: Reduce out-of-pocket costs like deductibles, copayments, and coinsurance for those with lower incomes who enroll in a Silver plan.

How Subsidies Affect Income Tax

Subsidy & Income Tax:

When you apply for coverage, you can choose to have your Premium Tax Credit paid directly to your insurance company to lower your monthly premium.
Alternatively, you can receive the credit when you file your tax return for the year.
If your actual income for the year is higher or lower than estimated, it can affect the amount of tax credit you’re eligible for, potentially resulting in a refund or additional taxes owed.

Poverty Level and Its Impact

Poverty Level:

  • The Federal Poverty Level (FPL) is a measure of income issued annually by the Department of Health and Human Services (HHS).
  • Your eligibility for ACA subsidies and programs like Medicaid is determined based on your income as a percentage of the FPL.
  • For example, an individual earning less than 138% of the FPL may qualify for Medicaid in states that have expanded their programs under the ACA.

Applying for ACA Coverage

Step 1: Assess Your Needs

  • Consider your healthcare needs, including any ongoing medical conditions, medications, and anticipated healthcare services.
  • Determine your budget for monthly premiums and out-of-pocket costs.

Step 2: Compare Plans

  • Use the Health Insurance Marketplace to compare different plans available in your area.
  • Evaluate the coverage options, provider networks, and costs associated with each plan.

Step 3: Apply and Enroll

  • Complete your application online, over the phone, or in person with assistance from one of our knowledgeable agents.
  • Provide all necessary information to determine your eligibility for subsidies or tax credits.

Why Choose Medinsco?

At Medinsco, we are committed to making the process of finding and enrolling in the right health insurance plan as seamless as possible. Here’s why you should trust us with your ACA needs:

Medicare Plan

Expert Guidance

Our experienced team provides personalized advice tailored to your specific healthcare needs and budget.

Medicare Enrollment options 2025

Comprehensive Support

From comparing plans to completing your application, we are here for you at any step you need us.

Medicare enrollment 2025

Customer-Centric Approach

We prioritize your health and financial well-being, ensuring you have the coverage you need without unnecessary stress.

Additional ACA Considerations

Pre-Existing Conditions:

  • One of the ACA’s most significant protections is that you cannot be denied coverage or charged higher premiums due to pre-existing conditions.
  • This ensures that everyone has access to necessary medical care without fear of financial hardship.

Enrollment Periods:

  • The Open Enrollment Period for ACA plans typically runs from November 1 to December 15 each year.
  • Special Enrollment Periods (SEPs) are available for qualifying life events such as marriage, birth of a child, or loss of other coverage.

Get Started Today

Ensuring you and your family have the right health insurance coverage is crucial for your health and financial security. At Medinsco, we make it easy to understand your ACA options and enroll in the right plan. Explore our website or contact us directly to learn more about your choices and start the enrollment process today. Let Medinsco be your trusted partner in securing comprehensive, affordable healthcare coverage through the Affordable Care Act.