Selecting the Right Plan Explained
The information you need to pick a plan with confidence
With more options than ever, it can be intimidating deciding on a plan. Factoring in monthly cost, coverage levels and confusing terminology can be difficult... Let us help.
Types of Plans
Some of my options are HMO plans and some are PPO plans. What is the difference?
HMOs are cheaper but offer no coverage whatsoever for providers that are out-of-network.
PPOs offer greatly enhanced benefits for in-network providers but some coverage is offered for out-of-network as well.
Is an HMO plan or a PPO plan better?
It depends on your situation. PPOs offer more flexibility and can prevent you from having to change doctors, however the cost savings of an HMO can make them a better option for many.
How can I look up the network of providers that are covered with my different plan options?
Each carrier has a unique list of in-network providers and drug formularies.
If you have a provider or drug you need, it is very important to double check before enrolling.
The easiest thing you can do is speak to an agent.
What is the fee to get a health insurance agent to help me pick out a plan?
While some agencies may charge a consultation fee, all advice and help that is offered at Elevate Insurance Solutions is completely free of charge.
This year is more confusing than ever so having a licensed professional on your side is essential.
All of the available plans have metals in their name. What do they mean?
Bronze plans are cheaper with less coverage, and Gold is the opposite.
To make things more confusing, the option with the best coverage is actually the Silver Enhanced plans for those under the income threshold.
Can I change to a cheaper ACA plan or one with better coverage at any time?
Unfortunately not. Open Enrollment ends January 15th and what you have chosen at that point is locked in until 2023.
(The one exception is if you have a qualifying life event)
If the Marketplace plan I choose has a monthly premium, how do I make the payment?
Each carrier has multiple options to pay. A bill will come through the mail, but for specific payment portal information for the carrier you have selected, it may be easiest to reach out to a trusted agent.
What happens if I'm late on my payment for a Marketplace plan?
With most carriers, after 30 days, the policy will be suspended. Any expenses incurred will be reimbursed once the full balance is paid, but expenses must be paid out-of-pocket until then.
After 90 days of non-payment, the policy will typically terminate and cannot be renewed until the following year.
Are there any alternatives to ACA Marketplace health insurance plans?
On-Exchange Marketplace plans are the right choice for most with few exceptions.
Two of the main alternatives for those looking to explore other options are Catastrophic plans and Short-Term plans.
What is a catastrophic plan?
A catastrophic plan is an unsubsidized policy that offers even less coverage than Bronze plans.
With high deductibles and minimal pre-deductible coverage, this policy only kicks in and helps with costs if something catastrophic happens.
What is a Short-Term health insurance plan?
Every few months, short-term policies have to be renewed. If the policyowner develops any conditions or submits any claims, they can be refused a renewal.
They fall outside ACA regulation so claims can be denied without consequence. We strongly recommend staying away from short-term plans.
Can I switch from a Short-Term plan to a Marketplace plan if I don't like it at any time?
No. Losing coverage during the year typically opens up a Special Enrollment Period, but short-term plans are the exception.
If you don't sign up for a Marketplace plan before the end of Open Enrollment, it will be the following Open Enrollment before you can enroll in ACA coverage.