Affordable Care Act

With all the politics and rhetoric around the Affordable Care Act, also known as Obamacare, it can be tough to know what exactly the ACA can do for you. In part, the ACA is there to overcome the rising price of private health insurance and medical costs. It’s also there to help people get health insurance who would otherwise do without. Here’s how you can sign up for an ACA plan and what it can do for you.

How To Enroll

When you’re looking at Massachusetts health care plans, or around the US, there are some rules to enrollment you need to know. There are two enrollment periods: open enrollment and special enrollment. Open enrollment occurs each fall from November 1 to December 15, although special circumstances like the recent pandemic can create additional open enrollment periods and some states with their own insurance marketplace offer additional times. For example, the Massachusetts open enrollment which begins on November 1, stays open through January 23 of the following year.

The good news is that once you’ve enrolled during open enrollment if you’re happy with the insurance, it will automatically renew each year without additional work on your part.

The other enrollment period is special enrollment. This is a rolling enrollment period based on changes in your personal circumstances. Qualifying changes include:

  • adopting or having a baby,
  • losing your existing coverage,
  • moving out of state, or
  • getting married or divorced.

You have 60 days before or after the event to enroll in updated insurance. You need to check with your state requirements to determine your exact special enrollment window.

What Enrollment Gets You

It’s important to understand that the ACA is more than subsidized private insurance plans. You may have heard about the Medicare expansion which is part of ACA. This means that more people qualify for Medicare, but it is separate from the insurance marketplace. The healthcare plans you buy at your state marketplace are subsidized by the government but are offered by traditional insurance companies like Anthem and Cigna.

To be eligible for a subsidy you must make between 100 and 400 percent of the federal poverty level. You can’t be eligible for other government programs like Medicare or Medicaid, and you can’t have access to health insurance through your job. Even if you make more than 400 percent of the federal poverty level, you can buy an ACA plan, but won’t receive a subsidy. These plans are not run by the government or controlled by them, except insofar as all health insurance has to meet federal guidelines.

The plans come in four levels: bronze, silver, gold and platinum. At the bottom, bronze plans cost the least but also have higher out-of-pocket costs. Platinum plans have the highest monthly premiums but provide the highest level of benefits. It’s important to balance what you can afford each month with what your projected medical costs will be. If you have a chronic illness, a higher-level plan could give you more benefits.

ACA plans are here to make health insurance a possibility in your life.

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