We work with more than 50 health insurance carriers that offer On-Exchange and Off-Exchange Plans. These plans are known as Affordable Care Act (ACA) or Obamacare plans. You have the option to check for savings eligibility and cost sharing reductions.
Who is this for?
Individuals and Families can apply for these ACA plans during open enrollment or Special Enrollment Period. You can filter plans that are accepted by your doctors and cover your prescriptions.
Joe who just turned 26 years old and getting off his parents health insurance plan. Joe can check for eligibility to receive subsidy based on his income for the current year.
Mary lost her employer’s coverage and she needs an equivalent coverage since she takes a prescription medication.
Change in Income
Marcus recently had a change in income and needed to check for his Medicaid Eligibility.
Qualifying Life Events that allow you to enroll in a health insurance plan: 🤔
Birth / Adoption / Foster Care
You have 60 days to enroll or change your health insurance plan due to adoption. Please make sure to contact us within 60 days to make changes.
You have 60 days from the date you get married to change, or enroll in a health insurance plan. You either choose to add your spouse to your health insurance coverage, get added to your spouse health insurance plan, or enroll in a new health insurance plan. Contact us within 60 days
If you move to a new address within the same state or a different state you are qualified to change your health insurance plan based on a special enrollment period.
Loss of Coverage (due to COBRA)
You are eligible to enroll in a health insurance plan when you lose your COBRA coverage, end your COBRA coverage, or when COBRA expires. You have 60 days from the loss date to enroll in a health insurance plan.
ICHRA or QSEHRA
ICHRA and QSEHRA: If you are employer started to offer a health reimbursement arrangement, you are eligible to enroll in a health insurance plan. Contact us or your employer for more information.
Consumer protections and benefits provided by the ACA include:
- Providing coverage for people with pre-existing conditions
- Eliminating annual and lifetime dollar limits on health insurance coverage
- Providing free preventive care
- Allowing young adults to remain on their parents’ plans until they are 26 years old
- Allowing people to compare health insurance coverage options before selecting a plan
- Providing premium tax credits to people who qualify to help lower health insurance costs
- Increasing access to Medicaid
Major Medical Coverage For ACA Plans
ACA health insurance plans offer coverage for rehab services such like: physical therapy. speech therapy, and behavioral therapy. Chiropractor visits are covered with limit on number of visits.
👶Maternity & Newborn
Your ACA health insurance plan covers pregnancy pre-natal and post-natal visits. Labor and delivery and the newborn medical services. You can add your newborn to your plan as well after delivery.
The health insurance plans offered on the marketplace follow the ACA rules where all pre-existing conditions are covered. The monthly premium is NOT calculated based on pre-existing conditions.
🚑 Emergency Room Coverage
Emergency Room visits and urgent care visits are covered under the ACA health insurance plan. You can visit any emergency room in any state regardless of the plan network. Urgent care visits are subject to copays and coinsurance.
🪥Dental & Vision for Children
Dependent children under 19 years old have dental and vision coverage included in the health insurance plan. No additional premium is needed for this coverage. Adults must enroll in a separate dental and vision plan if they want coverage.
💸No Annual Coverage Limit
ACA health insurance plans do not have an annual cap or limited coverage spend. Your plan must cover all approved medical services as per the ACA rules. Your are subject to copays and coinsurance.
The Affordable Care Act health insurance plans cover inpatient hospital visits. Inpatient and outpatient procedure are covered as well. Each plan has their own network of providers and hospitals. Out of network visits may cost you more out of pocket.
🔬Imaging, Blood Work, & Biopsies
X-rays, PET Scans, MRI, and CT scans are all covered under the ACA health insurance plans. Also, blood work and necessary biopsies taken by a licensed physician. You may have to pay a copay towards lab tests or images. Health plan have different in network laboratories.
Prescription drugs are covered under the ACA health insurance plan. The health insurance plan carrier may have different tiers of coverages for prescribed medications. Different tiers of drugs have difference copays. Generic drugs are the least costly for you.
What Are the Common Terms in Health Insurance?
You have probably heard these terms many times before and stared against the wall wondering the meaning. Smart Insurance Agents simplifies the health insurance world, the table below summarizes the most common terms used in health insurance.
Primary Care Doctor
What documents can I submit to verify income to marketplace?
- 1040 federal or state tax return. Note: It must contain your first and last name, income amount, and tax year.
- Wages and tax statement (W-2 and/ or 1099, including 1099 MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099SS, 1099INT). Note: It must contain your first and last name, income amount, year, and employer name (if applicable).
- Pay stub. Note: It must contain your first and last name, income amount, pay period or frequency of pay with the date of payment. If a pay stub includes overtime, please indicate the average overtime amount per paycheck.
- Self-employment ledger documentation (can be a Schedule C, the most recent quarterly or year-to-date profit and loss statement, or a self-employment ledger). Note: It must contain your first and last name, company name, and income amount. If you’re submitting a self-employment ledger, include the dates covered by the ledger, and the net income from profit/loss.
- Social Security Administration Statements (Social Security Benefits Letter). Note: It must contain first and last name, benefit amount, and frequency of pay.
- Unemployment Benefits Letter. Note: It must contain your first and last name, source/agency, benefits amount, and duration (start and end date, if applicable).
What documents can I submit for self employment income?
- 1040 SE with Schedule C, F, or SE (for self-employment income)
- 1065 Schedule K1 with Schedule E
- Tax return
- Bookkeeping records
- Receipts for all allowable expenses
- Signed time sheets and receipt of payroll, if you have employees
- Most recent quarterly or year-to-date profit and loss statement
What documents can I use to confirm unearned income?
- Annuity statement
- Statement of pension distribution from any government or private source
- Worker’s compensation letter
- Prizes, settlements, and awards, including court-ordered awards letter
- Proof of gifts and contributions
- Proof of inheritances in cash or property
- Proof of strike pay and other benefits from unions
- Sales receipts or other proof of money received from the sale, exchange, or replacement of things you own
- Interests and dividends income statement
- Loan statement showing loan proceeds
- Royalty income statement or 1099-MISC
- Proof of bonus/incentive payments
- Proof of severance pay
- Pay stub indicating sick pay
- Letter, deposit, or other proof of deferred compensation payments
- Pay stub indicating substitute/assistant pay
- Pay stub indicating vacation pay
- Proof of residuals
- Letter, deposit, or other proof of travel/business reimbursement pay
Achieved National Recognition
Recognized by CMS for helping more than 100 clients enroll in a Marketplace health insurance plan utilizing subsidies from Healthcare.gov.
Work with a Licensed Agent 👋
When you’re searching for a health insurance plan, it’s important to find a professional who can give you all the advice you need. A health insurance agent can advocate for you in negotiations with insurers, help you navigate through life changes, and help you re-shop during open enrollment. The regulations surrounding health insurance are changing all the time, and using a licensed agent is a much better choice. A licensed agent will be familiar with the various types of plans available and will know which ones are best for your needs.
How it Works?
We made signing up for health insurance simple. We understand the importance of health insurance to protect yourself and your family, hence, our goal is to provide you with a seamless integrated enrollment process.
Tell Us About You
Enter your Zip Code, DOB, and Doctors you want In Network
Review Available Plans
Review your savings eligibility and compare plans
Enroll in a Plan
Congratulations. Your coverage will start the first day of the following month
Frequently asked questions
What is Affordable Care Act health insurance?
ACA health plans are designed to give health coverage regardless of pre-existing conditions. These plans are designed to offer premium subsidies that (Advanced Premium Tax Credit).
Do ACA plans cover Dental and Vision too?
Some ACA plans offer Dental and vision coverage for Adults and other do not. However, most ACA plans offer Dental and Vision coverage for kids until age 19.
When Can I Sign Up for ACA Health Plan?
You can sign up for an ACA health plan during the Open Enrollment Period that runs from November 1st to December 15th. Otherwise, you can enroll during a Special Enrollment Period if you have a Qualifying Life Event.
How much does ACA health plan cost?
ACA health plans cost range based on many factors. Age and plan type (Bronze, Silver, and Gold) affects the rate. For example a Bronze plan have a high deductible and thus a low premium. However, you can find plans as low as $1 month.
How Many Days After a Qualifying Life Event do I have to Enroll in a Health Plan?
You have 60 days from the Qualifying Life Event to enroll in a health plan.
Can I Sign Up All My Family Members on The Same Health Plan?
Yes. You can add your spouse and dependents (under 26 years old) to the same health plan. We encourage you to add all your dependents and check for subsidy.
What is an out-of-network provider?
An out-of-network provider is a doctor, care professional (nurse practitioner, anesthesiologist, etc.) or facility (hospital, lab processing facility, ambulatory surgery center, etc.) that is not part of your health plan’s network.
Your health insurance plan negotiates with healthcare providers and facilities to provide services at lower rates, and that’s how doctors and hospitals become part of the network. Out-of-network providers do not have contracts with the health insurance company.
What happens when I use an out-of-network hospital or provider?
Your out-of-pockets costs (like copayments, coinsurance, and deductibles) will be higher. That is because you are charged the full price for a service, and not the lower, negotiated rate you would pay through the health insurance plan network.
I have gone to an in-network hospital. All of the providers there are in network, right?
Not necessarily. For example, if you go to a network hospital to get an MRI, the doctor reading the MRI may not be in the network. That doctor may charge the full price for the service, not the lower negotiated rate allowed for a network provider.
What is an allowable charge?
An allowable charge (sometimes called the allowed amount) is the amount the health insurance company allows for a covered health care service. Another term is “Maximum Allowable Fee”
What if I have an emergency?
In a true emergency, you should visit the nearest emergency room. If you receive emergency services from an out-of-network doctor or hospital, your costs may be more than they would be from a network provider. And, you may also be billed for the difference between what the provider charges and what your health insurance plan allows.
What is balance billing?
Balance billing is when an out-of-network provider bills you for the difference int their charge and what the your health insurance plan will allow. For example, let’s say an out-of-network doctor charges $100 to review your MRI, but your plan will only allow for $70. The doctor may bill for the remaining $30 in addition to what you may owe for your deductible or coinsurance.
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