Learn About Your Coverage Options
with the Affordable Care Act
Here are some of the Top Carriers in Virginia:
Knowing Your Options is Important
The purpose of the Affordable Care Act was to provide all Americans with access to qualify health care, along with insurance that is both attainable and affordable.
The legislation has in effect led to two categories of health plans:
- Plans mandated by the state and/or federal government, known as “Government Plans”, and
- Those plans that are not mandated by the government, or “Non-Government Plans.”
As you shop for health insurance, it is important for you to understand the difference between these two categories.
Government Plans are those explicitly created by the Affordable Care Act. You can only get a Government Plan during the Open Enrollment Period. The only exception is that if you missed Open Enrollment, you may be able to sign up if you have a Qualifying Life Event
All Government Plans are required by law to provide you with what are known as the “Essential Health Benefits.” These benefits include hospital/emergency coverage; preventative services; maternity and pediatric care; rehabilitative services; mental health services; prescription drug coverage; and more.
Important: If you do not have a health plan that meets the definition of Essential Health Benefits, you will face a tax penalty. All Government Plans and most of those offered by employers meet the Essential Health Benefit requirement. If you are currently uninsured, you must get a Government Plan to ensure that you are not penalized. Learn more about the penalties here.
There are five types of Government Plans in total. The first four are known as the “metal plans” and are categorized as:
What makes each metal plan different is not the coverage but the cost: how much you pay for your monthly or annual premium vs. how much the plan pays. All plans offer the same quality coverage.
Bronze Plans have the lowest monthly or annual premiums. However, with these plans you should expect to pay more out-of-pocket, or when you need medical services. Platinum Plans are the exact opposite; your monthly/annual rate is higher, but you pay a lot less out-of-pocket.
The fifth plan is the Catastrophic Plan. The premium on these plans is generally even less than Bronze Plans. However, and as the name suggests, these plans are primarily meant to protect you from catastrophic circumstances, such as an emergency or serious illness. The plans do allow for some preventive care though. You must have an income hardship and/or be under 30 years old to qualify.
To ensure that the plans are truly affordable, the Affordable Care Act has established a subsidy or “discount” program. Subsidies can significantly lower your costs. Currently, many uninsured Americans qualify for these cost benefits; however, you must meet certain income guidelines.
By entering your zip code and filling out the 1-page application, GovernmentHealthInsurance.com will direct you to the plans that best meet your eligibility. This information is also used to determine if you qualify for any subsidies.
Learn more about the differences among the five Government Plans here.
Non-Government Plans are those that are not supported by the government. These plans are very similar to how health insurance was before the Affordable Care Act. Unlike Government Plans, you can be denied coverage for preexisting conditions.
Also unlike Government Plans, Non-Government Plans do not meet the requirement for the Essential Health Benefits under the Affordable Care Act. This means that you may still face a tax penalty for not having a Government Plan because you are not considered to be sufficiently insured.
So why get a Non-Government Plan?
If you missed Open Enrollment and also do not have what is known as a Qualify Life Event-- or certain life changes that allows you to enroll in a Government Plan after Open Enrollment -- the only way to get health coverage is through a Non-Government Plans. It could be several months until the next Open Enrollment, and Non-Government Plans are a great temporary solution to bridge the coverage gap.
Non-Government Plans are a generally inexpensive way to protect yourself from the financial risk of not having any coverage. If you are uninsured, it just takes one unforeseen medical issue or emergency to lead to a tremendous financial strain from medical bills, which can lead to debt up to hundreds of thousands of dollars.
Learn more about Non-Government Plans here.
Finding the Right Plan
If you are not sure if you qualify for a Government or Non-Government Plan, please enter your zip code and fill-out the 1-page application. Based on your information, GovernmentHealthInsurance.com will help determine your eligibility.