Individual & Family Health Insurance Plans
See if you qualify for affordable health care coverage
WHAT IS THE AFFORDABLE CARE ACT (ACA)?
The Affordable Care Act is the comprehensive health care reform law enacted in March 2010. It allows private health insurance companies to offer individual/family health insurance plans. The plans offer minimum benefit levels, have maximum out-of-pocket limits, offer guaranteed-issue coverage (even with pre-existing conditions), and free preventative care. One goal of the act is to make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes
between 100% and 400% of the federal poverty level (FPL).
Who Qualifies to Enroll for ACA Through the Marketplace?
Individuals or families can enroll if you live in the United States, are a U.S. citizen/national or are lawfully present in the United States, not incarcerated, and not enrolled in Medicare. Those offered employee coverage are generally not allowed to enroll in a plan through the Health Marketplace.
Can I enroll at any time?
In Louisiana and most states, open enrollment for individual/family health plans runs from November 1 st through January 15 th . You will need to enroll by December 15 th to have a January 1 st effective date. Your plan will start February 1 st if you enroll between December 16 th and January 15 th .
What if I miss the Open Enrollment — is there a special enrollment period?
Normally, coverage is only available for purchase during the annual open enrollment period, but special enrollment periods allow people to sign up for coverage outside of that annual window.
In most cases, this requires a qualifying life event such as:
- Involuntary loss of coverage that meets the definition of minimum essential coverage
- A permanent move to a place where different health insurance plans are available
- Divorce, death, or legal separation that results in the loss of coverage
- A change in eligibility for ACA premium subsidies or cost-sharing reductions
- A change in citizenship or lawful immigrant status
- Your employer-sponsored health insurance is unaffordable or stops providing minimum value
- A change in household income that causes the applicant to leave the Medicaid coverage gap
- A change in household due to marriage, birth, adoption, or foster care
- Your income doesn’t exceed 150% of the federal poverty level
- You are turning 26 and leaving your parents’ health insurance plan
Choosing an Individual or Family Insurance plan
The Fussell Group Insurance Advisors has a team of licensed agents to help with plan selection and enrollment. Our services are at no cost to you. We will compare plans that have your doctors in-network and see how your medications will be covered. Consultations can be over the phone, at our office in downtown Covington, or in your home.
FAQs about the Affordable Care Act (ACA)
Who Qualifies for the Health Insurance Marketplace?
To qualify for a marketplace health insurance plan, you must meet these requirements:
- Live in the U.S.
- Be a U.S. citizen or national
- Not incarcerated
Can I enroll in a plan anytime during the year?
Open Enrollment is November 1st-January 15th. You may still be able to get health coverage at other times of the year if you have a life event that qualifies you for a Special Enrollment Period.
Can I enroll if I am offered job-based insurance?
If you have job-based insurance now or get an offer for job-based insurance, you won’t qualify for saving on a Marketplace plan if the job-based plan is considered affordable and meets minimum standards. Most job-based plans meet these standards.
Do pre-existing conditions make my premiums higher?
All Marketplace plans must cover treatment for pre-existing medical conditions. No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started.
Once you’re enrolled, the plan can’t deny you coverage or raise your rates based only on your health.
What do Marketplace health insurance plans cover?
All plans offered in the Marketplace cover these 10 essential health benefits:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
Do I have to pay a deductible and copayment for preventative services?
All Marketplace plans have some preventative services that are at no cost, and some plans cover other services without out-of-pocket costs.
Most health plans must cover a set of preventive services — like shots and screening tests — at no cost to you. This includes plans available through the Health Insurance Marketplace®.
What are "Advanced premium tax credits"?
Advanced premium tax credits help individuals and families with net incomes between 100 percent and 400 percent of the Federal Poverty Level (FPL) purchase health insurance in the federal or state Marketplace. If you qualify, you may have a premium as low as $0.