Here’s what to know about enrolling in ACA insurance during its annual Open Enrollment Period.

Don’t get health insurance from work, whether because you’re part of a small company, are self-employed or aged out of your parents’ coverage? It’s time to enroll in a comprehensive health insurance plan. One option Americans have is enrolling in an Affordable Care Act (ACA) plan.

You’ll likely have a lot of questions to answer before ACA’s Open Enrollment Period begins in November. Best of all, if you do your homework, you’ll be able to find health care options that offer coverage that fits your needs and budget.

Here’s what to ask as you’re getting started.

Need health insurance? Explore your options now, or contact a licensed insurance agent at 1-844-211-7730.

ACA question #1: How have your needs changed since last year?

Identify your current health care needs and your preferred doctors and medical facilities, as well as your prescription medication needs, suggests Robert Denhard, a spokesperson for the Ohio Department of Insurance.

“As you compare plans, make sure the doctors and facilities you’re using are in the plan’s network and that the plan covers your prescription drugs,” he says.

It’s worth taking the time to go back through your medical bills from the past few years to see what types of payments you’ve made. You can also figure out whether your health has changed in ways that might cause those costs to go up or down.

For example, you may have just been diagnosed with a chronic condition such as type 2 diabetes, heart disease or depression. Treating those conditions will come with multiple doctor visits, including trips to see specialists. Anticipating those needs as you compare plans is an important way to help determine how much coverage you may need.

ACA question #2: What will this plan cover, and how expensive will it be?

Once you have an idea of what your annual medical expenses might be, you can look at what those costs would work out to be in the various ACA plans you’re comparing. All ACA plans must cover 10 essential health services, including:

• Ambulatory patient services
• Emergency services
• Hospitalization
• Pregnancy, maternity and newborn care
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative and habilitative services and devices (such as wheelchairs)
• Laboratory services
• Preventive care/wellness services and chronic disease management
• Pediatric services, including oral and vision coverage (note: adult dental and vision coverage aren’t deemed essential health benefits under ACA)

So, you need not worry about having to shoulder big-time medical expenses involving those 10 benefit areas. What and how much you’re paying for specific nonessential services on an ACA plan will depend on how much your insurance company covers versus how much you pay.

For example, given that ACA plans only cover pediatric dental and eye services, that would mean you’d have to pay for a supplemental dental or vision policy to cover your oral and vision health.

Can’t get an ACA plan right now? You can always get alternative insurance plan details, or call a licensed insurance agent at 1-844-211-7730 to discuss your options.

ACA question #3: How much can you budget to pay for health coverage?

Knowing how much you’ll have to pay for a deductible before your plan kicks in is essential, says Denhard.

That’s because your deductible, or the amount you have to pay out of pocket before your insurance company pays the rest, is a big part of your annual costs. Another component of that is figuring out copayment amounts (fixed fees for health services) after your deductible is reached.

“Plans with lower premiums tend to have high deductibles and copayments,” says Denhard. That means you may be able to save money up front on lower premiums, but you’ll need to save some money to be used for the deductible and copays.

ACA question #4: Do you need preventive care screenings?

This is a bit of a trick question, because the Centers for Disease Control and Prevention advises that everyone get preventive screenings, such blood pressure, diabetes and cholesterol tests, as well as those for certain types of cancer.

But it’s possible that you may need more tests too, due to other factors, such as whether you smoke or are overweight or have a family history of certain chronic conditions.

For example, you may have quit smoking, but it’s a good idea to get a lung cancer screening based on how long you smoked. Or if heart disease runs in your family, your doctor may suggest that you get heart-related screenings earlier than usual.

ACA question #5: Oops, did you miss the Open Enrollment Period?

If you miss ACA’s Open Enrollment Period, you’re not out of luck. You may still be able to enroll in an ACA plan, or switch your plan, if you have what’s called a “qualifying life event.” That opens a window called a Special Enrollment Period, or SEP, which is usually 60 days. You can get an SEP if you:

• Experience a death in the family
• Get married or divorced
• Lose your job-based health benefits
• Move to a different state or coverage area
• Have or adopt a child
• Turn 26 and have to leave your parents’ plan

Looking for the individual or family health plan that’s right for you? Learn more now, or call a licensed insurance agent at 1-844-211-7730 to discuss your options.

Sources:

Centers for Disease Control and Prevention. “Promoting health for adults.” September 8, 2022. Retrieved from https://www.cdc.gov/chronicdisease/resources/publications/factsheets/promoting-health-for-adults.htm#clinical Accessed February 7, 2024

Centers for Disease Control and Prevention. “Screening tests.” June 20, 2023. Retrieved from https://www.cdc.gov/cancer/dcpc/prevention/screening.htm Accessed February 7, 2024

IRS.gov. “Publication 502 (2023), medical and dental expenses.” January 16, 2024. Retrieved from https://www.irs.gov/publications/p502 Accessed February 7, 2024

Compliance code:
50758-X-0524