Health Care Exchange: Affordable Care Act

Let us help you find your most affordable health plan!

The health care exchange (a.k.a. the marketplace) is the centerpiece of the Affordable Care Act, an online marketplace where consumers can shop around for health care plans. Because of the Affordable Care Act, citizens and those legally present in the US can obtain coverage during the annual enrollment period regardless of health or pre-existing conditions. Insurance companies are no longer allowed to exclude coverage for these conditions or charge additional premiums based on their existence.

A Copeland Insurance Group agent can help you navigate the marketplace and find the insurance plan that’s best for you. Many people even qualify for assistance with their plan premiums through tax credits! Some people pay under $30 per month!

In order to qualify, you must sign up during Open Enrollment, but could still be eligible for a Special Enrollment Period if you had a qualifying life event such as changing jobs, moving, getting married or divorced, etc. We can help you determine if you are eligible and help you find the plan that works best for you.

There are several plans and plan cost can greatly range, depending on the plan’s deductibles, co-pays, premiums, provider networks. We can help you compare several options and will assist you in understanding the plan benefits.

The Open Enrollment Period begins November 1st and extends until December 15th, and remember if you have a qualifying life changing event, you may qualify outside of the Open Enrollment Period for a Special Enrollment Period.

Is there a penalty if I don't enroll?

The individual mandate penalty was eliminated January 1, 2019, but if you don’t sign up during the enrollment period, you could be locked out of coverage all year. Let our agents help you determine if you qualify for a tax credit to pay some or maybe even all of your health plan premium! With the COVID-19 pandemic, the risk of not being insured is even greater. Many plans are even waiving copay's for testing and treatment related to the virus. You cannot be denied coverage for having COVID-19 or other pre-existing conditions; and remember, there are no annual or lifetime dollar limits on the benefits you receive.

What is the core package of health benefits?

The law ensures that health plans offer a core package of items and services, known as "essential health benefits." They must include items and services within at least the following 10 categories:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services
6. Prescription drugs
7. Rehabilitative and habilitative services
8. Laboratory services
9. Preventive and wellness services
10. Pediatric services, including oral and vision care

What are the options for young adults?

The Affordable Care Act allows 2.5 million young adults, who can't get coverage through their job, to stay on their parent's health plans until the age of 26. Turning 26 and losing your coverage under your parent’s policy also creates a special enrollment period.

What's the benefit for seniors?

The law protects any cuts to Medicare's guaranteed benefits, which include doctor, hospital and rehabilitation services.

The law adds free preventive care services:

1. Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
2. Alcohol misuse screening and counseling
3. Aspirin use to prevent cardiovascular disease and colorectal cancer for adults 50 to 59 years with a high cardiovascular risk
4. Blood pressure screening
5. Cholesterol screening for adults of certain ages or at higher risk
6. Colorectal cancer screening for adults 50 to 75
7. Depression screening
8. Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese
9. Diet counseling for adults at higher risk for chronic disease
10. Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over, living in a community setting
11. Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.
12. Hepatitis C screening for adults at increased risk, and one time for everyone born 1945–1965
13. HIV screening for everyone ages 15 to 65, and other ages at increased risk
14. Immunization vaccines for adults — doses, recommended ages, and recommended populations vary:
• Diphtheria
• Hepatitis A
• Hepatitis B
• Herpes Zoster
• Human Papillomavirus (HPV)
• Influenza (flu shot)
• Measles
• Meningococcal
• Mumps
• Pertussis
• Pneumococcal
• Rubella
• Tetanus
• Varicella (Chickenpox)
15. Lung cancer screening for adults 55-80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 year
16. Obesity screening and counseling
17. Sexually transmitted infection (STI) prevention counseling for adults at higher risk
18. Statin preventive medication for adults 40 to 75 at high risk
19. Syphilis screening for adults at higher risk
20. Tobacco use screening for all adults and cessation interventions for tobacco users
21. Tuberculosis screening for certain adults without symptoms at high risk