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Signing up for a new health scheme can be a very daunting task and without proper study and knowledge one can easily land himself in a lot of trouble. Same holds true while signing up for the Affordable Care Act. There are many aspects to this insurance cover that needs to be properly analyzed before opting for it, especially more and more new modifications getting introduced every year. The first and foremost thing to know about the Affordable Care Act is that it comes in four packages namely Bronze, Silver, Gold and Platinum. Hence ACA is also coined as the Metal Plans. Each plan comes with its own pros and cons and are constituted to target specific section of the society based on an individual’s or a family’s yearly income. The second most important thing is to know that the names of the plans does not signify their quality. For ex. Opting for a Bronze plan doesn’t mean that one is missing out on the coverage of key healthcare needs as compared to the one who has opted for the Platinum plan. The plans are meant to signify merely the amount of money an individual has to pay as compared to what his insurer will pay to cover his medical expenditure in a year. The third point to carefully ponder is that no matter from where an individual signs up for any plan (directly through government website, via a private insurance provider or through his employer) the rates always will remain the same. So, it is advised that an individual should make a conscious decision regarding his personal medical needs and the amount of money he can spare from his yearly income before opting for any plan. Provided below is a comprehensive analysis of the rates (as of 2018) an individual has to pay as against the insurers share per plan: For Bronze plan, the customer has to pay an average of 40% and his insurer has to pay around 60% of the total coverage. For the Silver plan a customer has to pay an average of 30% of the total coverage followed by the Gold and Platinum plan whereas the customer has to pay an average of 20% and an average of 10% of the total coverage respectively. It may come to mind that what the above figures actually mean for an individual. Below is a detailed analysis of the plans:
1. Deductible: $6000 Med/$500 Rx
2. For doctor visits: $70 for first 3 visits.
3. For seeing specialists: $90 after the deductible amount
4. Lab Testing: $40
5. X-Ray: 100% of the cost
6. Maternity: 100% of the cost
7. Out-Patient surgery: 100% of the cost
8. Hospital Stay: 100% of the cost
9. ER Visit: 100% of the cost
10. Urgent Care: $120 after the deductible amount
11. Out of Pocket: $6500 for individual/ $13000 for family
12. Generic Rx: 100% up to $500 after the deductible amount
13. Brand Rx: 100% up to $500 after the deductible amount
14. Preventive: $0
1. Deductible: $2250 Med/$250 Rx
2. For doctor visits: $45.
3. For seeing specialists: $70
4. Lab Testing: $35
5. X-Ray: $65
6. Maternity: 20% of the cost after deductible
7. Out-Patient surgery: 20% of the cost after deductible
8. Hospital Stay: 20% of the cost after deductible
9. ER Visit: $250 after deductible
10. Urgent Care: $90
11. Out of Pocket: $6250 for individual/ $12500 for family
12. Generic Rx: $15
13. Brand Rx: $50 after deducting Rx.
14. Preventive: $0
1. Deductible: $0
2. For doctor visits: $35
3. For seeing specialists: $55
4. Lab Testing: $35
5. X-Ray: $50
6. Maternity: $600 on a daily basis or 20% on the total cost
7. Out-Patient surgery: $600 on a daily basis or 20% on the total cost
8. Hospital Stay: $600 on a daily basis or 20% on the total cost
9. ER Visit: $250
10. Urgent Care: $60
11. Out of Pocket: $6200 for individual/ $12400 for family
12. Generic Rx: $15
13. Brand Rx: $50
14. Preventive: $0
1. Deductible: $0
2. For doctor visits: $20
3. For seeing specialists: $40
4. Lab Testing: $20
5. X-Ray: $40
6. Maternity: $250 on a daily basis or 10% on the total cost
7. Out-Patient surgery: $250 on a daily basis or 10% on the total cost
8. Hospital Stay: $250 on a daily basis or 10% on the total cost
9. ER Visit: $150
10. Urgent Care: $40
11. Out of Pocket: $4000 for individual/ $8000 for family
12. Generic Rx: $5
13. Brand Rx: $15
14. Preventive: $0
The above rates holds true for the state of California and may vary a little for other states. Judging by the above figures one needs to understand that if an individual suffers from a serious disease like cancer or diabetes and needs regular medical attention then the Bronze plan is most suited to him whereas the Platinum plans are most suited to individuals who rarely need medical attention and even if they do so, it’s only for some nominal health treatment. There’s another plan which is offered as part of the ACA which is termed as the Catastrophic Plan. This plan is only applicable in case of adults who age 30 years or less and need very nominal medical treatment. Adults outside the age limit may also be considered but only in certain cases. Apart for all the ten medical benefits that are offered as part of the ACA the Catastrophic plan holders will also receive additional benefits of three free visit to doctor for routine checkup per year and free preventive services. However an important point to be noted is that this plan has the highest deductible and highest costs out of pockets as compared to other metal plans and insurers will only pay once the deductible amount has been crossed. However, compared to other Metal plans this is the best option to select for healthy adults. The greatest advantage of the ACA is that it has an upper limit to the amount that has to be borne by the customers and all the exceeding amount has to be borne by the insurers. Moreover with the exception of the Catastrophic plan subsidies are provided by the American government against each plan which can significantly help the customers who fall below the poverty line.
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I am authorizing a licensed Health Insurance Agent to review, to submit into a free plan or to refer my Health Insurance enrollment to a qualified entity whenever deemed necessary. I as a customer allow access to my Healthcare.gov or Medicaid accounts to make any updates/uploads as necessary and also to review and advise year to year, using any and all reasonable efforts to ensure that I the customer have a sound decision in my Healthcare plan for the year. I as the customer agree that I qualified for one of the many SEP’s during the year of 2022. (Ex: qualified for unemployment, Covid 19, Etc) I as a customer acknowledge receipt of HIPPA Privacy Information at the time of enrollment. By filling out and providing my personal information and signing, I certify that all of the above information is correct to the best of my knowledge and I give authorization to be enrolled into a free health insurance plan.
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