Health Insurance Plan

The Beacon Difference

The Beacon team of agents are licenced to carry several insurance options which enables us to find the perfect one for your situation. Our experience and attention to detail allows the quickest processing possible. Using an agent will ensure your plan combines the best budget and your preferred medical network. As one of our clients, we will be with you to answer questions and guide you throughout the life of your insurance needs.

PPACA (PATIENT PROTECTION & AFFORDABLE CARE ACT)

Rhonda Wise Shaking hands with customer

The Beacon team of agents are licenced to carry several insurance options which enables us to find the perfect one for your situation. Our experience and attention to detail allows the quickest processing possible.  Using an agent will ensure your plan combines the best budget and your preferred medical network.  As one of our clients, we will be with you to answer questions and guide you throughout the life of your insurance needs.

The Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA) or “Obamacare,” is a United States federal statute that was signed into law by President Barack Obama on March 23, 2010. The ACA was enacted to:

  • Increase the quality and affordability of health insurance
  • Lower the uninsured rate by expanding public and private insurance coverage
  • Reduce the costs of healthcare for individuals and the government.

ESSENTIAL HEALTH BENEFITS

Beginning in 2014, insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace. States expanding their Medicaid programs must provide these benefits to people newly eligible for Medicaid.

  • Outpatient care
  • Emergency room visits
  • Treatment in the hospital for inpatient care
  • Maternal and pre- and post- natal care

Mental health and substance use disorder services including behavioral health treatment, counseling, and psychotherapy

  • Prescription drugs
  • Services and durable medical equipment to help you recover if you are injured and/or have a disability or chronic condition including physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
  • Lab tests
  • Preventive services including counseling, screenings, and vaccines
  • Pediatric services including dental and vision care

PREEXISTING CONDITIONS

Beginning in January 2014, exclusions by the insurance industry regarding pre-existing conditions are no longer allowed.

MINIMUM ESSENTIAL COVERAGE

For More Information marketplace Plans please visit heathcare.gov

The following healthcare plans meet the minimum essential coverage required under the health care law. Please check with your plan administrator to ensure your plan qualifies.

  • Any marketplace plan, or any individual insurance plan you already have
  • Any job-based plan, including retiree plans and COBRA coverage
  • Medicare Part A or Part C
  • Most Medicaid coverage
  • The Children’s Health Insurance Program (CHIP)
  • Most individual health plans you bought outside the Marketplace, including “grandfathered” plans. (Not all plans sold outside the Marketplace qualify as minimum essential coverage.)
  • If you’re under 26, coverage under a parent’s plan
  • Self-funded health coverage offered to students by universities for plan or policy years that started on or before Dec. 31, 2014 (check with your university to see if the plan counts as minimum essential coverage)
  • Health coverage for Peace Corps volunteers
  • Certain types of veterans health coverage through the Department of Veterans Affairs
  • Refugee Medical Assistance
  • State high-risk pools for plan or policy years that started on or before December 31, 2014 (check with your high-risk pool plan to see if it qualifies as minimum essential coverage)

The following list includes the essential health benefits.

  • Ambulatory patient services (outpatient care you get without be admitted to a hospital)
  • Emergency Services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity, and newborn care (both before and after birth)
  • Mental health and substance use disorder services including behavior health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills
  • Laboratory services
  • Preventative and wellness services and chronic disease management
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

Additional Benefits

Plans must also include the following benefits.

  • Birth control coverage
  • Breastfeeding coverage

Essential health benefits are minimum requirements for all Marketplace plans Specific services cover in each broad benefit category can vary based on your state’s requirements.  Plans may offer additional benefits, including:

  •  Dental coverage
  • Vision coverage
  • Medical management programs (for specific needs like weight management back pain , and diabetes)

PENALTY

Over the past few years, the terms “Obamacare”, “Affordable Care Act, and “Marketplace” have taken over the health insurance world. While all of these terms mean the same thing, there are now different ways of obtaining health insurance and we can help you make the best decision for you and your family.  Individuals are required to have health insurance coverage or risk being fine. If you don’t have coverage, you will pay the higher of these two amounts:

  • 2.5% of the household income per person, with the maximum amount you owe totaling the yearly premium for the national average price of a Bronze plan sold through the Marketplace.
  • $695 per adult, and $347.50 per child under 18 with a maximum penalty of $2,085
  •  The penalty fee is adjusted each year.

SUBSIDY

Financial assistance from programs is available to help people with low and middle incomes pay for their health insurance.

COST SHARING CREDITS

Cost Sharing Reduction Subsidies lower the amount you have to pay out-of-pocket for deductibles, coinsurance, and copayments. They can also reduce the maximum out-of-pocket costs you are responsible for in a policy period. These are only available on Silver plans bought through the MarketPlace.

ON EXCHANGE VS OFF EXCHANGE

On exchange plans are purchased through the Federal MarketPlace. Off exchange plans are purchased directly through the MarketPlace.

OPEN ENROLLMENT

Open enrollment is the period of time during which individuals that are eligible to enroll in a Qualified Health Plan can enroll in a plan in the Marketplace  Nov 1st through Jan. 31st.

QUALIFYING LIFE EVENTS

Qualifying life events include:

  • Marriage
  • Childbirth
  • Loss of coverage
  • Change in income
  • Other major happenings

There 4 basic types of qualifying life events. (The following are examples, not a full list)

  • Loss of health coverage
    • Losing existing health coverage, including job-based, individual, and student plans
    • Losing eligibility for Medicare, Medicaid or CHIP
    • Turning 26 and losing coverage through a parent’s plan
  • Changes in household
    • getting married or divorced
    • Having a baby or adopting a child
    • death in the family
  • Changes in residence
    • Moving to a different ZIP code or country
    • A sutdent moving to for from the place they attend school
    • A seasonal worker moving to orfrom the place they both live and work
    • Moving to our from a shelter or other transitional housing
  • Other qualifying events
    • Changes in your income that affect the coverage you qualify for
    • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement act (ANCSA) Corporation shareholder
    • Becoming a U.S. citizen
    • Laving incarceration (jail or prison)
    • Americorps members starting or ending their service

BRONZE, SILVER, GOLD, PLATINUM

Each metal tier corresponds to an actuarial value. Actuarial value is calculated by computing the ratio of total expected payments by the plan for essential health benefits and cost-sharing rules.

  • A bronze plan is required to have an actuarial value of 60 percent. Therefore, covered individuals would be expected to pay 40 percent through deductibles, co-pays and other cost-sharing features.
  • A silver plan is required to have an actuarial value of 70 percent.
  • A gold plan is required to have an actuarial value of 80 percent.
  • A platinum plan is required to have an actuarial value of 90 percent.

CATASTROPHIC PLANS

Health plans that meet all of the requirements applicable to other Qualified Health Plans (QHPs) but that don’t cover any benefits other than 3 primary care visits per year before the plan’s deductible is met. The premium amount you pay each month for health care is generally lower than for other QHPs, but the out-of-pocket costs for deductibles, copayments, and coinsurance are generally higher. To qualify for a catastrophic plan, you must be under 30 years old OR get a “hardship exemption” because the Marketplace determined that you’re unable to afford health coverage.

GRAND-FATHERED PLANS

A group health plan that was created or an individual health insurance policy that was purchased, on or before March 23, 2010 are exempted from many changes required under the Affordable Care Act. Plans or policies may lose their “grandfathered” status if they make certain significant changes that reduce benefits or increase costs to consumers.