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Call Us At (386) 401-5644 During

The Open Enrollment Period

ACA Plans-Obamacare-Marketplace Insurance

Finding an Affordable Care Act Plan that you can afford isn’t always as easy as it sounds. USA Benefits Group makes it easier to navigate the health insurance plans offered through the Affordable Care Act by finding out what your specific needs are and helping you navigate the different plans to find the best match for you.

open-enrollment obamacare

To get an ACA Plan (sometimes unofficially called Obamacare), Call USA Benefits Group at (386) 401-5644 during the open enrollment period. (In Florida and most other states, that’s November 1 – January 16. Some states extend that until January 31st.)

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What If It Isn't During The Open Enrollment Period?

Set up an appointment with us even if it isn’t during the open enrollment period. You may qualify for a Special Enrollment Period (SEP) if it is outside of the Open Enrollment Period (OEP). Even if you don’t qualify for an SEP, we will help you compare different plans, understand the benefits, and determine the best option based on your healthcare needs and budget. There’s nothing wrong with planning ahead.
As brokers, USA Benefits Group offers every available plan option so you can count on us for an unbiased recommendation. Using a licensed professional to assist with your enrollment will ensure accuracy and help prevent any surprises come tax time.
USA Benefits Group is here to help you every step of the way. Our experts will also help you navigate your state’s Insurance Marketplace. Ready to find your perfect ACA or other Healthcare Plan? Contact USA Benefits Group today, and let us guide you towards securing the health coverage that’s right for you and your family. Fill out this form or click here to schedule an appointment.

Shopping for Aca Health Insurance?
Here is What You Need to Know

More Information About ACA Plans & USA Benefits Group

Marketplace Health Insurance

The USA Benefits Group Team is dedicated to the principles of service, integrity, professionalism and diversity.

We know it can be difficult to navigate the complexities of choosing the right insurance plan through the Affordable Care Act and the Health Insurance Marketplace.

We work hard to simplify everything and help you find the Affordable Care Act Plan that best fits your needs. 

Frequently Asked Questions About ACA Plans

Coverage and Exemptions

Client Testimonials

About USA Benefits Group

Set Your Appointment With

USA Benefits Group Here
Get A Self-Quote By Filling In A Few Details

See Plans And Prices
Call Us At (386) 401-5644 During

The Open Enrollment Period

ACA Health Insurance Coverage And Exemptions

Under the Affordable Care Act (ACA), initial rules imposed a federal tax penalty on individuals without health insurance that met the ACA’s minimum essential coverage criteria.

This federal penalty has since been eliminated, but some states continue to enforce their penalties for lack of coverage. To understand the specifics and whether they affect you, consulting a tax advisor within your state is advisable.

For those potentially facing a state penalty, various exemptions could be applicable, ranging from income and health coverage circumstances to group membership or hardship conditions.

If you suspect you might qualify for an exemption, detailed information on potential waivers and the process for application is available at Healthcare.gov, covering both fees and exemptions.

Set Your Appointment With

USA Benefits Group Here
Get A Self-Quote By Filling In A Few Details

See Plans And Prices
Call Us At (386) 401-5644 During

The Open Enrollment Period

USA Benefits Group Client Reviews

Kim Olden
Kim Olden
A pleasure to do business with. Very knowledgeable.
Gregory C
Gregory C
I have to tell you how frustrated I was with the insurance company and dealing with the people that did not have the knowledge nor the compassion when speaking to me. THEN NATHAN CALLED ME!!!!!!!!! I spent probably half hour on the phone talking about not only the issues that I was having but just some personal stuff and he was amazing knowledgeable, compassionate. I COULD NOT ASK FOR ANYBODY BETTER TO HANDLE MY INSURANCE NEEDS
Pam Waine
Pam Waine
Nathan at USA Benefits is professional and courteous. It is a pleasure to deal with a company that still believes in customer service.

Frequently Asked Questions About ACA Plans

What is the difference between ACA plan metal tiers (Bronze, Silver, Gold, and Platinum)?
ACA plans are categorized into four metal tiers based on cost-sharing between you and the insurance provider:
  • Bronze: Lowest monthly premiums but highest out-of-pocket costs. The plan pays approximately 60% of covered healthcare expenses, while you pay about 40%. Suitable if you want low premiums and don’t expect frequent medical care.
  • Silver: Moderate premiums and out-of-pocket costs. The plan covers about 70% of healthcare expenses, leaving you with 30%. If you qualify for cost-sharing reductions, you must choose a Silver plan to receive those extra savings.
  • Gold: Higher premiums with lower out-of-pocket costs. The plan pays around 80% of covered expenses, and you pay 20%. Ideal if you anticipate needing regular medical care and can afford higher monthly premiums.
  • Platinum: Highest premiums but the lowest out-of-pocket costs. The plan covers about 90% of healthcare expenses, with you paying 10%. Best if you require frequent medical services and prefer higher premiums for more comprehensive coverage.
These categories reflect the cost-sharing structure and do not indicate the quality of care. We know it can be complicated and that’s why we offer you assistance on choosing the right ACA plan. Set up an appointment here or contact us with your questions here.
Eligibility for subsidies, such as premium tax credits, depends on your household income and size:
  • Income Range: Generally, if your household income is between 100% and 400% of the Federal Poverty Level (FPL), you may qualify for premium tax credits. In some states, subsidies are available for incomes above 400% FPL.
  • Cost-Sharing Reductions (CSRs): If your income is below 250% of the FPL, you might qualify for CSRs, which lower out-of-pocket costs like deductibles and copayments. To receive CSRs, you must enroll in a Silver plan.
  • Application: You can check your eligibility and apply for subsidies through HealthCare.gov or your state’s health insurance marketplace.
  • For precise eligibility, it’s recommended to consult with a certified insurance navigator. Set an appointment with USA Benefits Group so we can help you with your application.

These acronyms represent different types of health insurance plans, each with its own network rules:

  • HMO (Health Maintenance Organization): Requires you to use a network of doctors and hospitals. You’ll need a referral from your primary care physician to see a specialist. Typically has lower premiums and out-of-pocket costs.
  • PPO (Preferred Provider Organization): Offers more flexibility in choosing healthcare providers and doesn’t require referrals for specialists. You can see out-of-network providers, but at a higher cost. Premiums are usually higher compared to HMOs.
  • EPO (Exclusive Provider Organization): Combines features of HMOs and PPOs. You must use the plan’s network of providers (except in emergencies), and referrals are generally not needed for specialists. Premiums and out-of-pocket costs vary.
  • POS (Point of Service): A hybrid plan where you pay less if you use doctors, hospitals, and other healthcare providers that belong to the plan’s network. Requires referrals to see specialists. Allows out-of-network visits at a higher cost.

Choosing the right plan depends on your healthcare needs, budget, and preference for provider flexibility. USA Benefits Group is dedicated to helping you choose the ACA Plan that best suits your needs and income. Set up an appointment free of charge and we’ll be happy to help you figure out the base ACA Plan for your unique situation.

Selecting the right plan involves evaluating several factors:

  • Healthcare Needs: Consider your current health status and anticipated medical services. If you have chronic conditions or expect frequent doctor visits, a plan with higher premiums but lower out-of-pocket costs (like Gold or Platinum) might be beneficial.
  • Budget: Assess how much you can afford in monthly premiums versus out-of-pocket expenses. Bronze plans offer lower premiums but higher costs when you need care, while higher-tier plans have higher premiums and lower out-of-pocket costs.
  • Provider Network: Ensure your preferred doctors and hospitals are in the plan’s network to avoid higher out-of-pocket costs.
  • Prescription Coverage: Check if your medications are covered under the plan’s formulary and understand the associated costs.
  • Additional Benefits: Some plans offer extra services like dental, vision, or wellness programs.

 

Set up a free appointment today and we’ll be happy to answer all of your questions and find an ACA plan that matches your needs.

Coverage for specific doctors and prescriptions varies by plan:

  • Doctors: Each plan has a network of preferred providers. To determine if your doctor is in-network, check the plan’s provider directory available on the insurer’s website or through HealthCare.gov.

  • Prescriptions: Plans have a formulary, which is a list of covered medications. Review the formulary to see if your prescriptions are included and at what cost tier.

If maintaining access to specific doctors or medications is important to you, we can help you verify their inclusion in the plan’s network and formulary before enrolling. The easiest way to get all of your questions answered is to make an appointment with USA Benefits Group and let us help you navigate the choices. It’s our goal to simplify everything for you. You can also contact us using this form and we will reply as soon as possible.

You can enroll or change your ACA health insurance plan during specific timeframes:

    • Open Enrollment Period (OEP):
      • In most states, OEP runs from November 1 to January 15 each year.
      • To have coverage effective January 1, you must enroll by December 15.
      • If you enroll between December 16 and January 15, your coverage will begin on February 1.
    • Special Enrollment Period (SEP):
      • You can enroll outside the OEP if you experience a qualifying life event, such as:
        • Losing employer-sponsored insurance
        • Marriage or divorce
        • Having a baby or adopting a child
        • Moving to a new state or coverage area
        • Gaining eligibility for Medicaid or CHIP
      • You typically have 60 days from the event to enroll in a new plan. It would be best if you contact us right away or set up an appointment as soon as possible to make sure this all gets done within that 60 day window,
    • Medicaid/CHIP Enrollment:
      • If you qualify for Medicaid or the Children’s Health Insurance Program (CHIP), you can enroll at any time throughout the year.
  • American Indian/Alaska Native (AI/AN) Enrollment:
    • If you’re a member of a federally recognized tribe, you can enroll or change plans at any time, not just during OEP.

What if I miss the deadline?

  • If you don’t qualify for an SEP and miss the OEP deadline, you may have to wait until the next year’s Open Enrollment to sign up for coverage. You don’t have to wait to set up an appointment do we can go over everything with you. Contact us here and we will reply as soon as possible.
  • If you urgently need coverage, you might consider Private Health Insurance. USA Benefits Group can help you select a plan that is extremely affordable, boasts a nation-wide PPO network, and is not based off of your income like the ACA.
  • Your best bet is to set up an appointment so we can find a healthcare plan that will keep you covered. Book an appointment here.
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USA Benefits Group, Insurance Broker In South Daytona, Florida

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