How do you know an Obamacare plan is an Obamacare plan? It’s easy to find out. All Affordable Care Act (“Obamacare”) plans must meet certain requirements, so they’ll have some things in common.
So, how can you tell if your health insurance is “Obamacare”? Simply follow the steps below:
1. Look for the Metal Level
Does your health plan have a metal in its name? That means it’s an Obamacare plan. For example, say you have a plan named “Sendero Classic Silver.” Sendero is the insurance company, and Silver is the plan’s metal level.
While all Obamacare health insurance plans include certain benefits, the share of healthcare costs they cover varies. Every plan falls into one of four metal levels, categories that help you determine the percentage of costs a plan will pay. Metal levels include Bronze, Silver, Gold, and Platinum.
Bronze plans typically have the lowest premiums, which is the amount you pay each month to stay on the plan. However, these plans require you to pay the largest percentage of healthcare costs. Platinum plans have the highest premiums, but you pay the least out of pocket.
Below is a breakdown of the average percentage of healthcare costs covered by each metal plan:
o Insurance pays: 60%
o You pay: 40%
o Insurance pays: 70%
o You pay: 30%
o Insurance pays: 80%
o You pay: 20%
o Insurance pays: 90%
o You pay: 10%
2. Look for the Essential Health Benefits
All Obamacare plans include ten essential health benefits. These are categories of health services that must be covered under the Affordable Care Act.
Additionally, these benefits have no annual or lifetime limits, which means there is no cap on coverage for these services.
You can find out if your plan covers these by reviewing your Summary of Benefits and Coverage.
3. Check for Premium Tax Credits and Cost-Sharing Reductions
If you receive automatic financial help to pay for your coverage, you probably have an Obamacare plan. The Affordable Care Act lets plan members apply for two types of assistance: premium tax credits and cost-sharing reductions.
A premium tax credit, or a “subsidy”, lowers the amount you pay each month for your plan. How much you save will depend on your annual income and the size of your household. If your plan has a discount each month, you can likely confirm that it is Obamacare coverage.
Note: Even if you don’t receive financial help, you have an Obamacare plan if it has a metal level and covers the 10 essential health benefits.
Obamacare Plan FAQs
Now that you know what insurance plans are under Obamacare, let’s take a look at some of the most common questions people ask about them.
When Do Obamacare Plans Start?
You can generally join Obamacare during the Open Enrollment Period from November 1st to December 15th each year. If you buy a plan during this time, your coverage will start on January 1st.
Can You Change Plans Under Obamacare?
If you experience a life event such as losing your health coverage, moving, getting married, or having a baby, you’re eligible for a Special Enrollment Period. You’ll have up to 60 days following the event to enroll in a new plan.
Can You Buy a Health Plan that Isn’t Obamacare?
You can buy a plan that isn’t Obamacare at any time. You don’t have to wait for open enrollment.
A few alternatives to Obamacare include short term health insurance, faith-based plans, and fixed-indemnity plans. While these plans are typically cheaper, they don’t offer the same comprehensive coverage, and most people don’t consider them to be full health insurance. You can also be denied coverage for these plans on account of a pre-existing condition.
If you bought one of these plans in 2018, you may have to pay a penalty when you file taxes. The 2018 “Trumpcare” law repealed the tax penalty starting in 2019.
How the Affordable Care Act Changed Healthcare
Today, most individual and employer-sponsored health plans meet ACA standards. This means most health plans include all 10 essential health benefits and cover preexisting conditions. They all work in the same basic way. This wasn’t the case before recent healthcare reform.
If you’re buying your own health insurance, an Obamacare plan is likely your best choice for coverage. Although other plans are available, you won’t get as many benefits and could be denied coverage for a pre-existing condition.
Looking for an Obamacare plan? Use our comparison tool below to find out which ones are available in your area.
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