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The healthcare exchange (a.k.a. the marketplace) is the centerpiece of the Affordable Care Act, an online marketplace where consumers can shop for healthcare plans. Because of the Affordable Care Act, citizens and those legally present in the US can obtain coverage regardless of health or pre-existing conditions during the annual enrollment period. Insurance companies can no longer exclude coverage for these conditions or charge additional premiums based on their existence.

We can help you navigate the marketplace and find the best insurance plan. Many people even qualify for assistance with their plan premiums through tax credits! Some people pay under $30 per month!

To qualify, you must sign up during Open Enrollment. However, you could still be eligible for a Special Enrollment Period if you had a qualifying life event such as changing jobs, moving, getting married or divorced, etc. We can help you determine if you are eligible and help you find the plan that works best for you.

There are several plans, and plan costs can greatly range depending on the plan’s deductibles, co-pays, premiums, and provider networks. We can help you compare several options and will assist you in understanding the plan benefits. The Open Enrollment Period begins November 1st and extends until December 15th, and remember, if you have a qualifying life-changing event, you may qualify outside of the Open Enrollment Period for a Special Enrollment Period.

Is there a penalty if I don't enroll?

The individual mandate penalty was eliminated on January 1, 2019, but if you don’t sign up during the enrollment period, you could be locked out of coverage all year. Let our agents help you determine if you qualify for a tax credit to pay some or even all of your health plan premiums! With the COVID-19 pandemic, the risk of not being insured is even greater. Many plans even waive copays for testing and treatment related to the virus. You cannot be denied coverage for having COVID-19 or other pre-existing conditions, and remember, there are no annual or lifetime dollar limits on the benefits you receive.

What is the core package of health benefits?

The law ensures that health plans offer a core package of items and services known as "essential health benefits." They must include items and services within at least the following ten categories:

            1. Ambulatory patient services

            2. Emergency services

            3. Hospitalization

            4. Maternity and newborn care

            5. Mental health and substance use disorder services

            6. Prescription drugs

            7. Rehabilitative and habilitative services

            8. Laboratory services

            9. Preventive and wellness services

            10. Pediatric services, including oral and vision care

What are the options for young adults?

The Affordable Care Act allows 2.5 million young adults who can't get coverage through their job to stay on their parent's health plans until age 26. Turning 26 and losing coverage under your parent’s policy also creates a special enrollment period.

What's the benefit for seniors?

The law protects any cuts to Medicare's guaranteed benefits, which include doctor, hospital, and rehabilitation services.


The law adds free preventive care services:

             ● Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked

             ● Alcohol misuse screening and counseling

             ● Aspirin use to prevent cardiovascular disease and colorectal cancer for adults 50 to 59 years with a high cardiovascular risk

             ● Blood pressure screening

             ● Cholesterol screening for adults of certain ages or at higher risk

             ● Colorectal cancer screening for adults 50 to 75

             ● Depression screening

             ● Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese

             ● Diet counseling for adults at higher risk for chronic disease

             ● Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over living in a community setting

             ● Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence and        U.S.- born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B  prevalence.

              ● Hepatitis C screening for adults at increased risk, and one time for everyone born 1945–1965

              ● HIV screening for everyone ages 15 to 65 and other ages at increased risk

              ● Immunization vaccines for adults — doses, recommended ages, and recommended populations vary:

           ○ Diphtheria

           ○ Hepatitis A 

           ○ Hepatitis B

           ○ Herpes Zoster

           ○ Human Papillomavirus (HPV)

           ○ Influenza (flu shot)

           ○ Measles

           ○ Meningococcal

           ○ Mumps ○ Pertussis

           ○ Pneumococcal

           ○ Rubella

           ○ Tetanus

           ○ Varicella (Chickenpox)

● Lung cancer screening for adults 55-80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 year

● Obesity screening and counseling

● Sexually transmitted infection (STI) prevention counseling for adults at higher risk ● Statin preventive medication for adults 40 to 75 at high risk

● Syphilis screening for adults at higher risk

● Tobacco use screening for all adults and cessation interventions for tobacco users

● Tuberculosis screening for certain adults without symptoms at high risk

Major Life Change on the Way?

Reporting Life & Income changes to the Marketplace

Once you have Obamacare (ACA) Marketplace coverage, you must report certain life and income event changes. This information may affect the coverage or savings you're eligible for.

When and How to Report Changes?

You should report these changes as soon after the change as possible. If the changes qualify you for more or less savings, making adjustments as soon as possible is important.


After we help you report changes to the Obamacare (ACA) Marketplace, you'll get new eligibility results that explain: Whether you qualify for a Special Enrollment Period that allows you to change plans or are eligible for different savings.

At that point, we can help you shop for a different plan, and you usually have up to 60 days from the qualifying event date to enroll in a new plan.

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