You need to get an individual health plan or a policy in the Affordable Care Act (ACA) exchanges, but where do you begin? Here’s a step-by-step checklist to getting the coverage you need.
The ACA created the exchanges, which launched in 2014. The exchanges make it easier for Americans to get health insurance on their own. All plans on the exchange, also called the marketplace, must cover 10 essential health benefits. These benefits include maternity, prescription drug, mental health and outpatient coverage. The ACA also limits out-of-pocket costs. The amount may depend on the plan or your income.
What all this means is that the plans will offer you at least minimum consumer protections. So, you won’t have to worry about your insurer declining your application or your prescription drug purchase.
The exchanges provide that protection, but you still need to research plans before choosing a health plan.
In this article, we’ll give an overview of the ACA exchanges’ open enrollment period, review your options and take you through what you need to sign up for an individual or family plan.
Sign up during open enrollment
You can only sign up or make changes to your individual health plan during open enrollment. The open enrollment period in most states is between Nov. 1, 2019 and Dec. 15, 2019. There are a handful of states that have longer open enrollments:
- California -- Oct. 15, 2019 to Jan. 15, 2020
- Colorado -- Nov. 1, 2019 to Jan. 15, 2020
- District of Columbia -- Nov. 1, 2019 to Jan. 31, 20120
- Massachusetts -- Nov. 1, 2019 to Jan. 23, 2020
- Minnesota -- Nov. 1, 2019 to Dec. 23, 2019
- New York -- Nov. 1, 2019 to Jan. 31, 2020
- Rhode Island -- Nov. 1, 2019 to Dec. 23, 2019
You can’t sign up for or change a health plan in the exchanges outside of the open enrollment period unless you have a qualifying life event. This could be losing eligibility for other health coverage, such as your spouse losing a job. You can also qualify for a special enrollment for certain life events, including having a child, getting married or moving.
If you go through a qualifying life event, you can sign up for a plan or change an existing plan outside of open enrollment.
Before digging into the different ACA exchange plans, let’s go over what you will need in the application process.
Here’s what you should gather before looking for a plan:
- Name, contact information, date of birth and Social Security number for you and every member of your household who needs coverage or is listed on your federal tax return.
- Incarceration status for anyone for whom you’re applying.
- Immigration status, document type and number for any member of your household who is an immigrant.
- Job information about you and every member of your household. That includes wages and employer work information. You’ll want to fill out the Employer Coverage Tool for any household member with a job who’s getting coverage through your plan.
- Your other household income. You’ll include child support, veterans’ payments and Supplemental Security Income (SSI).
- A list of federal tax deductions that you claim.
- Specifics about any health insurance coverage anyone has in your household. Include coverage type, name of person, insurance company, policy number, etc.
You can start your application process once you have all the information that you’ll need.
The ACA forbids a health insurer from denying you or charging you much higher rates because of your health status.
Before the ACA, insurers could reject people, charge them exorbitant fees or drop them if they used health insurance too much. The ACA ended those practices.
You’re now guaranteed health insurance regardless of your health.
To apply for an ACA plan, you can go online, by phone, with in-person help, through an agent or broker or with a paper application. You can call 1-800-318-2596.
If you go online, you’ll set up an account with a username, password and security questions. You can then move onto the application. You’ll choose your state and it will take you to the right place. Some states have their own marketplaces. The site will transport you there if needed.
Use the information you gathered earlier to answer all the relevant questions, such as your personal information.
Subsidized health plans
Once the website has all of your information, it will tell you if you’re eligible for subsidies or credits. The ACA plans offer tax credits and lower rates for people who are lower-middle class and middle class.
For instance, you’ll qualify for tax credits if you earn up to 400% of the federal poverty level. That’s $103,000 for a family of four in 2020. The tax credit is meant to help you pay for coverage.
If you earn up to 250% of the federal poverty level, which is about $63,000 for a family of four, you’ll be eligible for lower deductibles and copayments, too. The website will provide cost information for each plan with your income in mind.
Types of plans
Once you enter in the information, the website will tell you what plans are available. All plans available on the exchanges cover the 10 essential health benefits, such as mental health and outpatient coverage.
There are four “metal” plans in the ACA exchanges:
- Bronze -- Insurer pays 60%; you pay 40% (these plans have the cheapest premiums, but highest out-of-pocket costs)
- Silver -- Insurer pays 70%; you pay 30% (higher premiums than Bronze, but fewer out-of-pocket costs than Bronze)
- Gold -- Insurer pays 80%; you pay 20% (higher premiums than Silver, but lower out-of-pocket costs than Silver)
- Platinum -- Insurer pays 90%; you pay 10% (highest premiums, but lower out-of-pocket costs than the other three plans)
You might be tempted by a Bronze’s plans low premiums. However, if you expect to visit medical providers frequently, you’ll pay more in out-of-pocket costs than if you had a different plan. Therefore, a Gold or Platinum plan might save you money.
If you don’t expect frequent visits to medical providers, a Bronze or Silver plan might work best.
Also, note that the less expensive plans might have limited provider and hospital networks. These narrow-network plans could mean you won’t get to see your doctor or go to the hospital of your choice. Confirm that your doctor and hospital takes the specific plan before signing up.
After you evaluate your options and decide how you’ll pay the premiums, you’ll choose a plan and sign up.
Make sure to consider your next year of potential health costs when making your decision. Once you find the plan that best fits your needs, the website will let you choose your plan and you’ll usually get coverage on the first day of the next month.
Bridget Mintz Testa contributed to this report.