Friendly Health Insurance GuyOran Rose, Heber City, Utah

ACA Marketplace guide

The Affordable Care Act, explained.

By Oran Rose, licensed agent

The ACA is a 2010 law that made health insurance available to everyone, regardless of health, and created the Marketplace where you can buy it, often with help from tax credits.

Who it's for

Anyone under 65 who doesn't get affordable coverage through work, Medicare or Medicaid. Insurers can't turn you down or charge more for pre-existing conditions.

The metal tiers

Plans are grouped by how costs are split between you and the insurer. The metal says nothing about the quality of the doctors.

TierMonthly premiumCost when you use careGood fit if
BronzeLowestHighestYou rarely see a doctor and want protection from big bills.
SilverModerateModerateYou may qualify for extra savings on deductibles and copays.
GoldHigherLowerYou see doctors often or take regular prescriptions.
PlatinumHighestLowestYou expect a lot of care and want predictable costs.

Help paying for it

Depending on household size and income, you may get a premium tax credit that lowers your monthly payment. Some Silver-plan enrollees also get lower deductibles and copays. The income rules have changed several times in recent years, so I check the current numbers for your household on every call.

When you can enroll

Open Enrollment starts every November 1. Outside it, you can enroll within a set window after a qualifying life event such as marriage, a new baby, moving or losing other coverage.

Not the only option

If you're healthy and your tax credit is small, a private plan may cost far less. I quote both every time.

See your real prices. My plan shopper shows every Marketplace plan in your county with your estimated tax credit applied. No phone number needed.

ACA questions, answered

Is Obamacare the same thing as the ACA Marketplace?
Yes. Obamacare is the nickname for the Affordable Care Act. The Marketplace (HealthCare.gov, or a state exchange) is where you buy ACA plans and apply for tax credits.
Can I be turned down for a pre-existing condition?
No. ACA Marketplace plans must accept you and can't charge more because of your health history. Pregnancy, diabetes, cancer history and mental health conditions are all covered.
How do premium tax credits work?
If your household income falls in the eligible range, the government pays part of your premium directly to the insurer each month. The credit is based on your expected income for the year and is reconciled on your tax return.
What happens if I miss Open Enrollment?
You can still enroll within 60 days of a qualifying life event such as losing job coverage, moving, getting married or having a baby. Otherwise you'll usually wait for the next November 1, or look at a private plan, which can start most months.
Should I pick Bronze, Silver or Gold?
It depends on how much care you expect to use. Bronze has the lowest premium and highest deductible; Gold is the reverse. If your income qualifies for extra savings, a Silver plan can have Gold-level benefits at a Silver price.
Do I pay more if I use an agent?
No. The plan costs exactly the same whether you enroll through HealthCare.gov, HealthSherpa or with my help. My help is free to you.

Questions are free. So is my time.

Book a relaxed call and leave knowing exactly what you're paying for and why.

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