A Step-by-Step Checklist to Obtain an Individual Plan on a Health Insurance Exchange

Individuals looking to buy a health plan

The Affordable Care Act created the exchanges at both federal and state levels to allow Americans easily and conveniently obtain health insurance without any hassle and inconvenience. All the health plans that are available on the exchange are called the marketplace plan and provide coverage for the ten essential health benefits that include prescription drug, maternity benefits, mental health, hospitalization, and outpatient coverage. The out-of-pocket costs have also been limited by the ACA, and the amount usually depends on the plan and the applicant’s income. This means that people having an individual’s plan will have at least minimum consumer protections and they won’t have to worry about the insurance carriers declining their application or their prescription drug purchase. A certain level of protection to the people is ensured by the exchange and people still need to research the plans available in their area before finally choosing a health plan.

Sign-up for a Health Plan

Individuals looking to buy a health plan can sign up only during the open enrollment period which in most of the states starts from November 1 and ends on December 15. Albeit there are a few states that have longer open enrollment periods. States with longer open enrollment periods are:

California, District of Columbia, Nevada, New Jersey, and New York – Nov. 1, 2020, to Jan. 31, 2021

Colorado – Nov. 1, 2020, to Jan. 15, 2021

Massachusetts – Nov. 1, 2020, to Jan. 23, 2021

Minnesota – Nov. 1, 2020, to Dec. 22, 2021

People can sign up for a new plan or make changes in their existing health plans only during the open enrollment period. Outside the open enrollment period, only people with qualifying lifeĀ  events are allowed to enroll in a health plan or make changes in their plan. People qualify for a special enrollment period if they lose eligibility for other health coverage like their spouse lose a job, or on getting married, moving to a different place, or having a child. On going through any of the qualifying life events, people can sign up for a plan or make a change in their existing plan outside of the open enrollment period.

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Vital Documents

Prior to exploring different ACA exchange plans people need to arrange some of their documents that will be required in the application process. Find below vital information and documents that will be required while applying for a health plan.

  • Individuals will require their name, contact information, date-of-birth, and Social Security numbers as well as of every member of their families who require health coverage or who all are listed on their federal tax return.
  • Information related to an individual’s job and every member of their household which includes wages, and employer work information. Individuals will also require to fill out the Employer Coverage Tool for any household member having a job and getting coverage through the individual’s plan.
  • Immigration status, type, and document number for any household member who is an immigrant.
  • Incarceration status of the member for whom one is applying for a plan.
  • A list of federal tax deductions that individuals have claimed.
  • Individual’s other household income includes child support, veterans’ payments, and Supplement Security Income.
  • Specific details of any health insurance coverage which anyone in the family is having. details like coverage type, person name, an insurance company, and policy number, etc.

After collecting all the required information, people can start their application process.

Application Process

The Affordable Care Act has prevented health insurance carriers from denying and charging higher premiums to any individual due to their health status. Before the implementation of the Affordable Care Act, health insurance companies could reject people’s application, or charge them exorbitant fees, or drop their coverage if they used too much of their health insurance. All such practices of the insurers were ended by the ACA and now people are guaranteed to have health insurance regardless of their health.

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Individuals can apply for an ACA plan either online, or through phone, or with in-person help, or through an agent, or with a paper application. People who choose to apply online need to set up an account with a username, password, and security question. Then they can move onto the application by choosing their state and they will be directed to the right place. Some of the states have their own marketplace and so residents of these states will be directed to their state marketplace and residents of the states that don’t have their own marketplace will be directed to the federal marketplace. Here people will be required to provide their personal information, as they have to answer all the relevant questions.

Subsidized Health Plans

After providing all the required information on the website, the applicants will be informed if they are eligible for subsidies or credits. All the ACA plans provide lower rates and tax credits to people belonging to the middle-class and lower-middle class. People who earn up to 400% of the federal poverty level will qualify for tax credits that help people to pay for the coverage. People will find information related to the health plan cost with respect to their income at the health insurance exchange website.

Different Types of Health Plans

The health insurance exchange website after receiving the required information from the applicants will tell them about the available health plans. Usually, there are four metal categories of health plans available in the ACA exchanges:

Bronze Plan

Bronze is the most popular ACA plan that has the cheapest premiums and highest out-of-pocket costs. In the bronze plans, the health insurance carrier pays 60% of the healthcare costs and the insured pays 40% of the cost.

Silver Plans

Silver plans have higher monthly premiums compared to Bronze plans but lower out-of-pocket costs than the Bronze plan. The health insurance carrier pays 70% of the healthcare costs and the insured pays 30% of the cost.

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Gold Plan

Gold plans have higher monthly premiums than Silver plans but lower out-of-pocket costs than Silver plans. Health insurer pays 80% of the healthcare costs and the insured pay 20% of the costs.

Platinum Plans

Platinum plans have the highest monthly premiums but lower out-of-pocket costs compared to the other three plans. Health insurer pays 90% of the healthcare cost and the insured pay 10% of the cost. Only 2% of ACA plan members have a Platinum plan so at times finding a Platinum plan in one’s area is really tough.

People are often seen tempted toward the Bronze plan due to low monthly premiums, but people who expect to frequently visit healthcare providers will end up paying more in out-of-pocket costs compared to other plans. Thus, in such circumstances, people might save money with a Gold or Platinum plan. people who don’t have to frequently visit the medical providers may opt to buy a Bronze or Silver plan.

Besides, people should also keep in mind that the cheapest health plans may have limited healthcare providers and hospital networks. The limited network of healthcare providers would mean that people will not be able to visit the doctor or hospital of their choice. People first need to confirm with their doctor and hospital that they take the specific plan before finally signing it up. People need to considerĀ  their next year’s potential health costs when making decisions for purchasing a health plan. People should evaluate all their options well and decide upon the payment method before selecting a plan and sign up for it. After suggesting some plans that best fit the need of the people, the website will allow them to choose a plan of their choice and people will start getting coverage from the first day of the next month.

Find a Right Affordable Plan For You