ACA Plans

Understanding ACA Plans in Texas
At Dolphin Family Insurance we are here to help you understand the intricacies of the Affordable Care Act and highlight the different ACA plans that are available. The passage of the Affordable Care Act made it easier to qualify for Medicaid, and health insurance companies were forbidden from rejecting individuals from health coverage for having pre-existing conditions. Another result was the creation of Health Insurance Marketplace plans, which are divided into four different categories – bronze, silver, gold, and platinum.

All ACA plans must cover such items as hospitalizations, preventive services, prescriptions, mental health, and laboratory services.

What Are The Differences Between The Types of ACA Plans?
Plans differ in premium amounts, how much the insurance company covers, and who they’re ideal for.

Affordable Care Act Bronze plans are ideal for those who do not require frequent medical treatment. They have the lowest premiums, but the cost sharing places more financial responsibility on the policyholder compared to the coverage for the other plans. The deductibles are also high as well. With a bronze plan, the insurance company pays roughly 60% of the medical care costs, while you pay the remaining 40%.

Silver plans are the true middle ground with regards to ACA plans. The premiums and deductibles fall on neither end of the extreme. This is better for someone who gets routine appointments, and qualifies for additional savings. Once the deductible is met, your insurance will cover 70%, while you will pay 30% of your medical costs.

Gold plans are ACA plans which have high premiums, but are relatively low in other expenses. This is for those who need more frequent treatments. Once you meet your deductible, your gold plan will pay 80% for your services.

Lastly in the list of Affordable Care Act plans are platinum plans, which have the highest premiums, but have the lowest costs in other categories. The coverage is more immediate due to its low deductible. It covers 90% of medical costs, leaving you to pay the remaining 10%. Platinum plans are essentially the inverse of bronze plans.

When Can I Get A Marketplace Plan?
Health Insurance Marketplace Plan enrollment is available during the open enrollment period. This takes place between November and December.

Another time to join is during a special enrollment period. In 2024, the special enrollment period lasts until August 15.

But the special enrollment period also extends to those going through qualifying events that have occurred within the past 60 days. These are sudden and significant changes in life circumstances. Examples include getting married or divorced (if this results in current coverage changes), losing current health insurance coverage, and having a child.

The dates for when a qualifying event leads to effective coverage are exemplified here:

• For having a child, the coverage begins on the day of the birth.
• If getting married, you have until the last day of the month to join. Your coverage will then begin on the first day of the following month.