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What is

ACA?

The Affordable Care Act (ACA), also known as Obamacare, is a health care reform law that was signed into law in 2010 by President Barack Obama. The ACA's goals are to make health insurance more affordable and accessible to more people, and to protect consumers.

Overview of the ACA Market

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When is

OEP

OPEN ENROLLMENT PERIOD

NOVEMBER 1ST - DECEMBER 15TH TO BE ELIGIBLE JAN 1ST

CAN GO UP TO JAN 15TH ON FEBRUARY 1ST

NOVEMBER 1ST ALL CLIENTS MUST BE CALLED TO RENEW AND CHECK IF APPLICATION STAYED THE SAME

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To be

Eligible

Quality Assurance

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Must live in the United States
Must be a U.S. citizen or national (or be lawfully present). More about eligible immigration statuses.
Cannot be incarcerated in prison or jail

Under the Affordable Care Act (ACA), you have special patient protection when you are insured through the Health Insurance Marketplace:

Insurers cannot refuse coverage based on gender or a pre-existing condition.
There are no lifetime or annual limits on coverage for essential health benefits.
Young adults can stay on their family's insurance plan until age 26.

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What is

Marketplace

There is a wide range of Health Insurance Marketplace plans to choose from. They offer coverage for not only medical care but also dental and vision.

Each state's Marketplace has its own enrollment instructions.

During the Marketplace open enrollment period each year, you can:

Choose a plan for the first time
Continue in your current plan
Make changes to your current Marketplace insurance plan
Choose a new plan to replace your current plan

If you experience a life event like moving or having a baby, you may be able to change your coverage during a special enrollment period. You may also qualify for a special enrollment period if your household income is below a certain amount.

The amount you pay for your health insurance may depend on where you live, your income, and the size of your household. Health insurance costs include a premium, which is what you pay for your insurance plan each month. But, if you seek health care services, you may also have to pay out-of-pocket costs. Learn about these out-of-pocket costs, including:

EVERYONE IS DIFFERENT

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Overview

Marketplace plans must provide coverage for the following items and services in the 10 EHB categories:

1.Ambulatory patient services (like doctor and clinic visits)

2.Emergency services (like ambulance, first aid, and rescue squad)

3.Hospitalization

4.Maternity and newborn care

5.Mental health and substance use disorder services, including behavioral health treatment

6.Prescription drugs

7.Rehabilitative and habilitative services and devices (like, therapy sessions, wheelchairs, and oxygen)

8.Laboratory services

9.Preventive and wellness services and chronic disease management (like blood pressure screening, and immunizations)

10.Pediatric services, including dental and vision care

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BRONZE LEVEL

SILVER LEVEL

GOLD LEVEL

PLATINUM LEVEL

a health plan that has an AV of 70 percent (Consumers pay 30 percent on average)

a health plan that has an AV of 80 percent (Consumers pay 20 percent on average)

a health plan that has an AV of 90 percent (Consumers pay 10 percent on average)

a health plan that has an Actuarial Value (AV) of 60 percent (Consumers pay 40 percent of costs on average)

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For coverage to become effective, consumers generally must pay the first month’s premium directly to their insurance company by the insurer’s deadline.

Consumers must pay the premium each month or they could lose coverage.

§Issuers of individual and family Marketplace plans must accept at least these payment methods:

ØPaper check

ØCashier’s check

ØMoney order

ØElectronic fund transfer (EFT)

ØGeneral-purpose pre-paid debit card

Some issuers may also accept online, credit card, or debit card payments (check with the plan).

PREMIUM PAYMENTS

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TERMINATION

OF COVERAGE

Consumers may want or need to end their Marketplace insurance plan if they get other health coverage, or for other reasons.

How consumers should end their Marketplace plan depends on whether the consumer is:

1.Terminating the plan for everybody, or

2.Terminating coverage for only some people on the application.

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LETS OPEN HEALTH SHERPA

HealthSherpa is a California-based technology company focused on connecting individuals with health coverage. The site was initially developed as an alternative to research plans from Healthcare.gov

https://www.healthsherpa.com/?_agent_id=stefany-ferrell-dwjdgw

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Thank You

My Phone

305-989-8646

More Information

c.raybenitez@gmail.com

for attention