ACA / Major Medical Health Insurance Plans
When offering major medical insurance, agents have the opportunity to help individuals and families secure essential healthcare coverage, provide guidance in selecting suitable plans, and build long-term relationships with clients. It's important to note that the specific benefits and features of major medical insurance plans can vary depending on the insurance provider, policy terms, and local regulations.
A major medical health insurance plan is a type of plan that meets all of the minimum essential benefit standards of the Affordable Care Act (ACA or “Obamacare”). It also provides benefits for a broad range of inpatient and outpatient health-care services.
It’s important for you to understand that not all major medical health insurance plans can be purchased with a premium tax credit. However, enrollment in a major medical plan does protect you from tax penalties for being uninsured under Obamacare. Please note that as of the 2019 plan year, you’ll no longer pay a penalty in your federal taxes for going uninsured. However, state law varies, and you may owe a state tax penalty if you can afford the cost of major medical insurance but choose to go without it.
Cost of major medical insurance plans
Many factors will affect the cost of your health coverage, including the type of plan you enroll in, the services you need and how often, and whether you take prescription drugs.
When you’re calculating the cost of major medical insurance, it’s important to look beyond just plan premiums, or the monthly amount you’ll pay for coverage. Oftentimes, major medical plans with low premiums may be offset by other costs, such as higher deductibles or cost sharing, or a higher maximum out-of-pocket limit.
Choosing a plan
Choosing a health insurance plan can be complicated. Knowing just a few things before you compare plans can make it simpler.
The 4 “metal” categories: There are 4 categories of health insurance plans: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. Plan categories have nothing to do with quality of care.
Your total costs for health care: You pay a monthly bill to your insurance company (a "premium"), even if you don’t use medical services that month. You pay out-of-pocket costs, including a deductible, when you get care. It’s important to think about both kinds of costs when shopping for a plan.
Plan and network types — HMO, PPO, POS, and EPO: Some plan types allow you to use almost any doctor or health care facility. Others limit your choices or charge you more if you use providers outside their network.
Remember that plans also may differ in quality. Learn more about quality ratings.