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14 Simple Tips That Uncomplicate ACA and can Help You Qualify for ACA Plans aka Obamacare

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Written by: Benavest

BenaVest is an Insurance Agency dedicated to providing knowledge, services of Insurances like Health, Life, and Retirement. We want dedicate our time to bringing you the best services possible.

ACA

November 28, 2020

ACA aka Obamacare is not for everyone and was not designed for everyone. It was designed as an aid for low to moderate-income level consumers.  If you look at the full ACA model in states that expanded Medicaid, offer ACA Plans, and also include benefits to large and small employers you will see that it had almost all of the bases covered.  With one major exception “The ACA Gap,” which is a gap in coverage that unfortunately leaves close to 15 to 20% (60-80,000,000 people) of Blue Collar workers, without an affordable option (not that they had a real individual, pre-existing non-discriminant, major medical option before ACA). We list 3 income brackets below and what plans may fit best based on your household income and size.  We also list good and bad facts about ACA and our opinions on how to make the plan better. 

Please feel free to share with the right people so we can all have access to affordable health care one day and have the comfort of knowing we live in a community that is healthy and safe. 

The ACA Model is a good Program (depending on your household size and income). Please keep in mind If they work on correcting the gaps, the ACA Model could be a Great Plan:

1. Zero – Low-Income Consumers should qualify for Medicaid (Do NOT Qualify for ACA)

Medicaid Expansion was part of the plan that would cover Zero – Low-Income consumers.  Only 39 states expanded Medicaid. So if you live in a state like Florida, where Medicaid was not expanded, and you are out of work and can not get comprehensive major medical coverage or do not qualify for Obamacare, you can look to YOUR STATE GOVERNMENT for not approving expansion AND MAKE SURE YOU VOTE in favor of YOUR benefits in the future!!!  To check if Medicaid expanded in your state visit: https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/

 

2.Low – Moderate Income (Typically Qualifies for Good ACA Plans at Good Prices)

Our organization does feel that a good percentage(100-160,000,000 People) of the population qualify for good ACA plans at very good prices, there are also some MAJOR Gaps in affordability within the ACA model and we hope we can help address all of the issues eventually but for now we have addressed most of them below.  For a brief study on the household size, income benefits, and gaps, please reference: https://drive.google.com/file/d/1uV6W6TWh6wJR6lrbvM5T-EJnHm6x1eHQ/view?usp=sharing

3. Moderate to High-Income brackets (Typically Do NOT Qualify for Good ACA Coverage and or Prices)

For moderate to high-income brackets, there have been tax benefits and credits put in place for employers, so they can offer affordable coverage to their employees (like health insurance being tax deductible and subsidies for small group marketplace plans). If your employer is not offering you and your family affordable coverage maybe they have not done their homework and/or do not understand the new and existing benefits of offering employer coverage. Our organization feels that there could be some small changes made in additional benefits offered to employers that would allow for employers to offer more affordable health plan options which is one of the gaps that could easily be corrected. In the meantime, you and the other employees should start asking, WHY don’t you offer coverage like your competitors!  To check self-employed or employer coverage benefits and options visit https://www.benavest.com/group-health-insurance/ (or refer to this link to your HR Department)

If you do have a high income and are healthy, and you know your employer is not going to offer you coverage, you may find Short Term Medical Plans to be a good option in the meantime.  The prices for people with high incomes are more favorable but the plans do have coverage limits, unlike the ACA plans that have no limits. These plans cater to younger, healthy people, and may not accept pre-existing conditions. To check off-exchange Short Term Options visit: https://www.benavest.com/short-term-health-insurance/

 

4. Now that we understand why ACA is not for everyone, let’s talk about the benefits for the American people who qualify and also for who may fall into some of the affordability gaps in the ACA model.  We will start with some examples that show some great plans and then give some examples in certain income classes that we feel are not very fair and the financial assistance (subsidy/tax credit) and coverage are lacking: 

 

* Affordable: In these two examples we will point out two plans that are affordable:

  1. In this example, here we have a family of 4 with a $40,000 income, they qualify for ZERO DEDUCTIBLES, ZERO COPAYS, and $30 A MONTH WITH A GREAT NETWORK OF DOCTORS. 
  2. Affordable / Benefits not as Good:  In this example, here we have a family of two with a $40,000 income. They qualify for a similar plan but have to pay about $128 a month and the out-of-pocket expenses are also higher (example: a $3,800 deductible and $35 doctor copay). Now the plan is still affordable and also keep in mind that it is unlimited major medical. If they had a $500,000 bill, it would be covered and the out-of-pocket expenses could be paid in installments.

 

* Unaffordable: In these two examples we will point out two situations where we feel the ACA model is lacking in sufficient subsidies/financial assistance (this is where the divide of the 2 different individuals feel like the ACA model is either Great or Terrible).  There are people that we would consider Blue Color that still does not qualify for affordable coverage.

  1. Unaffordable: In this example, here we have an individual that is 50 years old at $45,000 income, the lowest price range of the silver plans is around $500 a month and the benefits are not very good with an out of pocket max of around $5000.
  2. Semi-Unaffordable: In this example, here we have a couple that has $50,000 in income. The couple would qualify for a decent plan with a $3000 deductible and $30 copay to see the primary doctor or a specialist at $70 for a total of $240 a month.  We could consider this affordable if the couple lived in a small town but let’s say the couple lived in Miami, FL where the cost of living is much greater, they would not be able to afford this plan.  

To check financial assistance and plan options please visit: https://www.benavest.com/obamacare-enrollment/

 

5. You have to have a job or earned income to get any financial assistance or qualify for Obamacare. To see what level of subsidy/financial assistance you qualify through the ACA Subsidy Calculator visit: https://www.kff.org/interactive/subsidy-calculator/

ACA Insurance Chart

6. Without the subsidy/financial assistance, Obamacare is VERY expensive because these are NOW highly regulated qualified plans. This means the insurance companies are not allowed to get over on people anymore by raising the rates if they get sick or denying you coverage if you are ill or have a disability (pre-existing condition)!  Individual Health Insurance is no longer a SCAM BECAUSE of ACA!

7. To qualify for ACA/Obamacare Plans, you have to pay taxes on income and have to be in the US legally and working towards citizenship.

8. Obamacare is for the working class / Blue Collar (though there are certain gaps that need to be addressed that some blue-collar workers fall into). 

9. Most of the old rules that allowed insurance companies to take advantage of people were made illegal because of Obamacare (like the NEW pre-existing conditions clause that does not allow them to deny you coverage because of pre-existing illnesses or conditions). For more info on that visit:https://www.healthcare.gov/search/?q=pre%20existing%20condition

10. The majority of people that are in need of Major Medical Healthcare are those above the age of 40 and/or are heading towards retirement and no longer get coverage from their employer. If it wasn’t for Obamacare most of those people would be left out to dry by insurance companies because by that age most people would possibly have some sort of “pre-existing” condition. 

11. There are great hospitals and doctors being added to Obamacare Plan Networks every day including well-known hospitals and doctor systems like Memorial Regional,  Broward Health, and the University of Miami. 

12. Qualified Obamacare Carrier Plans are through Major Medical Insurance Companies (ex: Cigna, Oscar, Ambetter, etc.) and even the Bronze Plans (which have higher deductibles and out of pocket expenses) are still the only real individual, pre-existing non-discriminant,  Unlimited Major Medical Option there is

 

Example: If you were seriously injured and hospitalized for 6 months and your bill was $1,400,000.00, and your out-of-pocket max was $2,000.00, you would only be responsible for $2,000.00 and the insurance company would have to cover the other $1,398,000.00. 

13. Working through the application for the Subsidy/Tax Credit/Financial Assistance is very complicated and should be done with a Licensed and Certified Agent (some questions are forward leading and projections). Consumers may make changes to incomes in time, to qualify for benefits, today even though the projections have not come to fruition yet.

14. The subsidies are based on your household income and size. The further you get from the minimum income requirements, the lower the amount of financial assistance available, and the more you will pay monthly for your coverage. You can reference the chart here: https://drive.google.com/file/d/1uV6W6TWh6wJR6lrbvM5T-EJnHm6x1eHQ/view?usp=sharing

When picking a plan, make sure the 3 main ingredients are there:

    • Good plan benefits like Low Copays, Deductibles & Prescriptions
    • A good selection of doctors who are in your Local Network
    • Make sure it’s affordable for you

 

If you would like assistance applying for the subsidy/financial assistance, checking your plan and network options, please don’t hesitate to visit Benavest.com or call us at 877-962-8332. Our Agents are licensed professionals, ready to help you and have your best interest at heart.  

All of us here at Benavest just want to help people get great affordable health coverage whether it’s Obamacare or Private Health Insurance – IT DOESN’T MATTER WE JUST WANT TO HELP!  We would also like everyone to keep in mind that we are a product of our environment.  We must do what we feel is necessary to make sure our surrounding neighbors are covered, because the same people that are of low income and high income go to school together, shop at the same stores, go to the same local amusement parks, and just share this great country together. Let’s do our best to make sure everyone has affordable healthcare coverage so all of our families can stay healthy!!

 

Hopefully, they start to work on these inadequacies moving forward and make it even more affordable. 

Some of this information comes from healthcare.gov and kff.org. We are using these sources for the numbers provided in this blog post and are estimating the numbers shown from these websites. Please understand that some of our estimations may be incorrect.

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