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August 15, 2016
If you don’t qualify for lower costs based on your income, you can get coverage 4 ways according to HealthCare.gov:
The only way to get a marketplace plan or cost assistance is through your state’s Health Insurance Marketplace. That being said, some major brokers and providers can help you find out if you qualify for subsidizes and some can help you enroll in a marketplace plan. So in some cases you have your choice between getting help from your state’s marketplace or from an outside broker or agent. The benefit to choosing an agent outside the marketplace (like us) is that they can present other non-marketplace plan options too.
This guide will help compare differences between ACA compliant plans and Non-ACA plans. Non-ACA plans can save you a great deal of money and offer greater access to providers. Having said that, Non-ACA plans aren’t for everyone. If you have significant health issues and very specific needs you may need to stay in an ACA plan. Keep reading for more information.
ACA Plan | Non-ACA Plan | |
---|---|---|
Nationwide PPO Network | No | Yes |
Cost | $$$$ – Expensive* | $$ – Reasonable |
Pre-Existing Conditions | Covered | Not covered |
Maternity, Mental Health & Preventive Care | Covered | Not Covered |
ACA Compliant | Yes | No* |
Rate Stability | Poor | Excellent |
Health Questions Required | No | Yes, 5 |
Enrollment Period | November 1st – December 15th | Year Round |
Compare |
Cost* – Those whose incomes are within the sweet spot can obtain sizable subsidies making their ACA plan little to no money.
Non-ACA Plan is a very generalized term that people use to describe anything that is not compliant with the ACA. The problem is that a lot of plans that aren’t actual insurance get lumped in like faith-based cost-sharing plans which are not insurance. There are also a lot of new plans from carriers that no one has ever heard of pushing plans that sound like the greatest thing since sliced bread. None of these have passed our sniff test and as a result, the only non-ACA plan that we recommend is Short Term Medical Insurance (STM). Due to recent changes in the law, these plans are now able to be purchased for 12-36 months at a time.
Due to recent changes in the law, these plans are now able to be purchased for 36 months at a time in many states.
STM plans are low-cost alternatives to the expensive ACA options. They are 100% real health insurance with large PPO networks. There are many benefit levels available to suit all budgets. While these plans do not cover pre-existing conditions and typically offer very little in the way of prescription coverage, they provide maximum premium savings.
This depends on you and your present health condition. We encourage you to visit iHealthAgents GoodRx Prescription Tool and review your own prescriptions to see if you can save any money. While STM plans typically don’t cover prescriptions (some actually do), for most healthy individuals this isn’t a concern. I personally take an expensive name brand prescription that costs me $300 a month even with GoodRx, however, that said, I’m saving $1,100 a month by choosing STM over an ACA plan so for me it still makes perfect sense.
A health care sharing ministry is an organization that facilitates sharing of health care costs among individual and families who have common ethical or religious beliefs. A health care sharing ministry is not actual insurance, is not regulated by the Department of Insurance, does not use actuaries, does not accept the risk or make guarantees, and does not purchase reinsurance policies on behalf of its members.
While members of these plans are exempt from paying the tax penalty for not having health insurance, there is still a significant risk to these plans. Because these plans are not actual insurance and because of the significant risk we do not endorse these plans.
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In summary shopping around for quotes on health plans is a smart move every open enrollment. The more you understand what the private insurance market offers, the better your chances of finding the best plan for you. That being said, if you qualify for cost assistance your best choice will almost always be a subsidized marketplace plan.
We’d be happy to have your join our team of independent agents.
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