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What do ACA plans cover?
10 Essential Health Benefits
The Affordable Care Act (ACA), also referred to as Obamacare or "Marketplace Insurance" refers to federal legislation designed to make health insurance more accessible and "affordable" for millions of American's. All Affordable Care Act plans must include 10 basic "essential" health benefits with no additional costs to you. These essential benefits are:
Outpatient Care
& Doctors Visits
Basic care you receive without being admitted to the hospital
Emergency
Services
Care and treatment at a hospital emergency room or for urgent medical issues.
Hospitalization
(Surgery & Overnight)
Treatment at a hospital including surgeries or overnight stays.
Pregnancy
& Newborn Care
Services and care including all stages of pregnancy - both before and after birth.
Mental Health &
Drug Treatment
Including behavioral health, counseling, psychotherapy and substance abuse.
Prescription
Drugs
Access to prescriptions - Including brand-name and specialty drugs
Rehabilitation
Therapies
Services like physical therapy, occupational therapy and speech therapy.
Laboratory
Services
Routine tests ordered by a doctor for diagnosis and treatment purposes.
Preventive &
Wellness Services
Annual physicals, cancer screenings, vaccinations, weight loss, smoking cessation and more.
Pediatric
Services
Children's medical care, including dental and vision coverage.
Pre-existing Conditions Covered
This may be the most significant change in health insurance. Health insurers under the ACA can no longer charge more, impose conditions or waiting periods, or deny coverage because of a pre-existing health condition such as asthma, diabetes, heart attack, cancer, or even pregnancy. They cannot "limit" benefits for any condition, either.
What Makes ACA Plans Affordable?
Premium Tax Credits
(Premium Assistance)
You may qualify for sliding scale "subsidies" that can reduce your monthly premiums, depending upon your household size, income and geographic location.
Cost Share Reductions
(Additional Assistance)
Your income level may qualify you for additional savings options with lower deductibles, lower copay and co-insurance costs out of pocket.
What do YOU qualify for?
Make Your ACA Plan Work Better
Once you choose an ACA plan that works best for you...let us help you enhance that coverage and make it work even better! Keep in mind that your ACA plan is considered "basic" medical coverage. There are still "gaps" in both coverage and out-of-pocket liability. Some of these gaps can quickly leave you in financial distress, if you are not prepared.
Your Basic Coverage "Gaps"
ACA plans give you access to quite a bit. More coverage than you may get without one. But there are still things that they do not include. That means money out of YOUR pocket - and they add up quickly. A few "basic" things that are not just part of an ACA plan would be Vision and Dental. We have a wide selection of the top companies, best and most widely accepted Vision and Dental plans, for individuals and families.
Your Even Greater "Liability"
The out-of-pocket liability for ALL plans is real and always there. The ACA helps many reduce that liability, but not completely. Statistically, 80% of people will never satisfy their deductible. Not every service applies toward a deductible. There are also services which may not be covered by ANY plan, regardless of the ACA. A few of these non-covered services are Elective or Cosmetic Procedures, Feterility Treatments, Off-label Prescriptions, Experimental Treatments/Procedures, Emergency Transportation, Hospital Room (and ancillary costs), Long-Term Care and many other services you may not know about until you get the bill.
Here is something MORE you need to think about. If you are hospitalized from a serious injury or illness...who pays your bills? How much money do you have saved to afford maintaining everything while recovering? Basic health insurance doesn't cover that. ACA plans definitely don't cover that. So what options do you have available to you?
Supplemental Insurance "Solutions"
Healthier Insurance Group provides you with real choices and real solutions. Our goal is always to look out for your best interests. We do this by providing the most comprehensive protection possible. These options are always your choice. We customize what is right for you, your family, your goals and your budget. This may include carefully selected health plans, life insurance and SUPPLEMENTAL INSURANCE plans, to create a customized package.
Supplemental Insurance plans are separate plans that pay a CASH BENEFIT directly to you. It's YOUR choice as to how to apply that benefit. This means you can use the benefit toward your deductible responsibility, copays, coinsurance, non-covered services, or even toward household bills and necessities, while recovering. They may not cover 100%, of course. But, what are you responsible for without them?
Choose supplemental coverage for Accidents, Injuries, Major Illness, Heart Attack, Stroke, Cancer, Surgeries, Hospitalizations, Long-Term Care and Treatment, etc. We may be able to offer "bundled" options, as a more comprehensive and affordable solution. The choice is always yours. No pressure. Our job is merely to advise, educate, help you qualify and apply - and when you need us, show you how to make the most of what you have chosen.