Affordable Care Act

What is Affordable Care Act?

The name Affordable Care Act or ACA is the name used to refer to the final, amended version of the comprehensive health care reform law and its amendments. The law addresses health insurance coverage, health care costs and preventive care.

If we used a certified agent, will that cost me extra?

No. Our commission is built into your premium whether or not you use Certified licensed Agents. Since our consultation is free, it could save you thousands of dollars. For this reason, do not risk thousand of dollars in potential tax penalties because you assumed the plan you bought through federal Health Insurance Marketplace better know as compiled with the law.

What is Health Insurance Marketplace?

The Health Insurance Marketplace is a resource where individuals, families, and small businesses can compare health insurance plans for coverage and affordability; get answers to questions about your health insurance; find out if you are eligible for tax credits for private insurance or health programs like Medicaid or the Children’s Health Insurance Policy (CHIP) and enroll in a health insurance plan that meets your needs.

Who can enroll in the Health Insurance Marketplace?

Most people can shop for coverage in the Insurance Marketplace. To be eligible, you must live in the state where your Marketplace is, you must be a citizen of the US or be lawfully present in the US and must not currently be incarcerated.

How is the health care law working in my state?

Each state may choose to operate its own Health Insurance Marketplace and to expand their Medicaid or Oregon Health Plan to serve low-income individuals and families. As a result, about 32 states use the federal Health Insurance Marketplace like Oregon and the rest uses their own state marketplace like Washington state.

Can I get coverage if I have pre-existing condition?

Yes. Under the Affordable Care Act, health insurance companies can’t refuse to cover you or charge you more just because you have a pre-existing condition. This refers to a health problem you had before the date that new health coverage starts.

Who’s not covered?

– Those who are Not US citizens or legal residents
– And Offered enrollment with eligible employer sponsored plan providing “minimum value and affordable”. Minimum value is at least 60% of the actuarial value (bronze plan). Affordable means no more than 9.5% of the employee’s W-2 income.

When can I enroll?

-Individuals or Families Health Insurance Annual Open Enrollment begins November 1 t0 December 15 and it takes it effect the beginning of the year.
-Employers on their anniversary date
-Small Business can enroll anytime

How can a health insurance agent help me?

We are experienced licensed agents in Health, Life, Property and Casualty markets. We also have Errors and Omissions insurance to help protect clients. We’re certified and trained with Federal Health Insurance Marketplace. Therefore, any error on your application can easily cost you thousands of dollars and we’re here to help.

Is there a penalty if I don’t enroll on a health plan?

No. There used to be a penalty but keep in mind Annual Open Enrollment period is only open or available from Nov. 1 till Dec 15 every year. If you didn’t enroll during this time frame, you will have to wait the following year to enroll and be covered.

What are covered through the Health Insurance Marketplace?


These essential health benefits include at least the following items and services:
1. Outpatient care – the kind you get without being admitted to the hospital
2. Trips to emergency room
3. Treatment in the hospital for inpatient care
4. Care before and after your baby is born
5. Mental Health and substance-use disorder services: This includes behavioral health treatment, counseling and psychotherapy
6. Your prescription drugs
7. Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech language pathology, psychiatric rehabilitation and more.
8. Your lab tests
9. Preventive services: It includes counseling, screenings, and vaccines to keep you healthy and care for managing chronic disease.
10. Pediatric services: This includes dental care and vision care for kids.


Who are not qualified for premium tax credits?

People who have coverage through their employers or enrolled in a government-subsidized health plans such as Medicare Insurance, Medicaid, Children’s Health Insurance Program and TRICARE are not eligible to receive premium tax credits.


What health plans are offered through the marketplace?

All health plans offered through the Health Insurance Marketplace must meet the requirements of creditable or qualified health plans. This must cover essential health benefits.

What are the different levels of metal tiers on ACA health plan?

Bronze plans are the cheapest because insurers pay only 60% of a policy holder’s covered health expenses, and the policy holder must come up with the other 40%
Silver plans split covered expenses 70%-30%. insurers pay 70% of the policy holder’s covered health expenses.
Gold plans split covered expenses 90%-10%. insurers pay 90% of the policy holder’s covered health expenses

What is the cheapest ACA/OBAMACARE health plan I can buy?

Bronze plans are the cheapest plans that at a minimum is required so you will not face any penalty. This health plan offers really high deductible and co-insurance that’s why its the cheapest.

How do I get financial assistance or tax credits through Affordable Care Act?

To qualify for tax credit or financial assistance, we need basic information about yourself, family or business. Any type of financial assistance is always based on the annual income of an individual, family or business. Hence, the process may feel like filing for your tax return. Its very important to put your expected income so you will get the most accurate financial assistance. In addition, financial assistance is also setup in a sliding scale of commercial premium tax credits for people making under 400% of the poverty level. This is $111,00 for a family of 4 or $54,360 for an individual.

Small business also gets more tax credits if the business has less than 25 employees. For people that makes less than 250% of the poverty level, they are eligible for cost-sharing or copay reductions. This means less out of pocket expense. Lastly, for people that makes less than 138% of the poverty level, they may enroll automatically in the low-income Medicaid or better known as Oregon Health Plan. 

>>> Click here to see Explainer Video


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