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Affordable Care Act / Marketplace Plans

Like a lot of people, your first question might be “What is the Health Insurance Marketplace?” or “What are Affordable Care Act (ACA) plans?”  The answer is easy for both.  Most people call these plans Obamacare.  A second point of confusion for many people is they believe they don’t qualify for ACA coverage.  Every American citizen and legal resident is eligible for an ACA plan.  The Affordable Care Act of 2010 established some basic criteria including acceptance regardless of one’s pre-existing conditions and inclusion of no-cost preventive care like an annual wellness visit.

An additional huge benefit many people can get when applying for an ACA plan is the Tax Credit.  People with income between 100% and 400% of the Federal Poverty Level who aren’t offered health insurance through their employer or any other government program like Medicare or Medicaid get a Premium Tax Credit that lowers their monthly payments.  For a family of four that’s a household income between roughly $25,000 and $100,000 and half those amounts for a single individual. Those with income up to 250% of FPL also qualify for reduced out of pocket costs like lower deductibles and copays.

Anyone can enroll into an ACA plan during Open Enrollment.

In most states, including Georgia, Open Enrollment happens from Nov. 1 through Dec. 15 annually.  During that time frame plans will have an effective date of Jan. 1 for the following year.  For the rest of the year, certain circumstances allow for a Special Enrollment Period (SEP).  A few examples of life changes that are qualifying events for an SEP are 1) moving to a new county/ZIP code with different plan choices, 2) losing employer group coverage, 3) children turning 26 and aging out of their parents’ plan.  Each of these SEP’s provides a 60-day window from the qualifying event to enroll into an ACA plan.  For applications completed by the 15th, the plan will be effective the next month.  There are other SEP options available (e.g. birth, marriage, etc.) for mid-year changes.

Please feel free to contact one of the agents at Senior Benefits of Georgia to check if you are eligible for a mid-year enrollment.  We have a lot of experience working with the ACA since 2015 so take advantage of our knowledge for a smooth transition process.  One of our agents, Michael Fleming, has been recognized in the Marketplace Circle of Champions in the past two years for helping people get signed up.  If you have any questions or just want to get an idea of what an ACA plan might look like for your family next year, please press here and fill out your info. One of our agents will contact you shortly.