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ACA / Marketplace

Name: BE Frank Insurance
Telephone: +12162878832
Price range: $$

Coverage before 65 or between employer plans.

What the Affordable Care Act does

The ACA’s (Obamacare’s) main focus is providing more Americans with access to affordable health insurance, improving the quality of health care and insurance, regulating the health insurance industry, and reducing health care spending in the US.
Americans can no longer be denied coverage because of preexisting conditions.
Preventive services are now covered at no charge.
There are essential benefits that are now covered for every American.
There are also a lot of new rules and restrictions.

During open enrollment you can use the marketplace to enroll in a new plan, change plans, verify cost assistance, enroll in Medicaid and CHIP, and apply for cost assistance.
Cost assistance — premium subsidies and out-of-pocket subsidies depending on income — is only available through the marketplace and can only be used on marketplace plans.
Minimum essential coverage matters for staying continuously covered, but there is no longer a federal tax penalty for being uninsured (it was reduced to $0 in 2019), and Ohio has no state penalty.
In the individual and family market, open enrollment is the only time you can switch plans or buy a new plan — whether through the marketplace or outside it.
If you miss open enrollment, you can’t buy a major medical plan that counts as minimum essential coverage unless you qualify for a special enrollment period.
You can enroll during the year if you have a qualifying life event:
- losing existing health coverage
- turning 26
- moving
- getting married or divorced
If you missed open enrollment, look into short-term plans.
Find out what qualifies as a life event (special enrollment period)

Short-term health insurance plans provide coverage for a limited period of time.
May be an ideal solution for those between jobs or waiting for other health insurance to start.
How long a short-term plan can last depends on current federal and state rules, which have changed several times in recent years; in some states an initial term can run up to 364 days with renewals. Check Ohio’s current limits before relying on one.
Things to consider about short-term plans:
- They are not minimum essential coverage — they don’t include the ACA’s essential health benefits, so they don’t meet the government’s definition of comprehensive health insurance
- They do not cover pre-existing conditions
- They are medically underwritten, so you must answer health questions
- Preventive services follow the plan’s rules and usually are not “free” as with ACA coverage
- They are usually cheaper than ACA plans for all of the above reasons

High-deductible plans are the most affordable and often make the most sense.
Unless you can easily handle a $6,000 or $8,000 bill, it’s strongly recommended to add an accident policy and a hospital confinement policy.
Most times one or both will pay out if you end up with large hospital bills.
The price of both policies together is much less than buying a low-deductible/copay plan.

Ask yourself:
- What doctors do you want to be able to see?
- What hospitals do you want access to?
- What prescription drugs are you taking?
- What is your budget?
- What matters more to you — lower premiums, or network/doctor flexibility?
- How often do you use your insurance?
Healthcare.gov is an excellent source for information, but working with a local broker familiar with health plans in your area is recommended.

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