...And am I being Penalized for not having one?
There’s still a ton of confusion surrounding the US’s approach to universal healthcare, coined Obamacare and now Bidencare. Whatever one chooses to call it, it is sold through the Marketplace (most often, but some states have their own version of the healthcare.gov site, but it serves the same product). The Marketplace came about through the Affordable Care Act (ACA) in March 2010, with good intention for those Americans who did not qualify for affordable coverage. Many Americans are born with preexisting conditions, by no fault of their own, and they find themselves in a never ending battle with insurance providers to get some of their basic healthcare needs met. The ACA stood to provide coverage for these individuals without an increased premium, as well as with assistance from Big Brother to cover the premiums, if one qualifies. The rules have changed over the years and one lesser known requirement that went out the window beginning with the 2019 coverage year is that Americans are no longer required to have a Qualified Health Plan; In the past, the ACA mandated monthly penalty fees to those individuals without one come tax time.
So what is a Qualified Health Plan? What does it have to do with the Marketplace?
A Qualified Health Plan (per Healthcare.gov) is an “insurance plan that’s certified by the Health Insurance Marketplace, provides Essential Health Benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements under the Affordable Care Act.” But what does that include? For the average American, it means we’re required to have more coverage than we actually need. A Qualified Health Plan covers pre-existing conditions, provides pregnancy/maternity/newborn care, birth control, breastfeeding care, free preventative care, mental health disorder services, substance abuse disorder services and the list goes on. For someone who needs all of the above and has a pre-existing condition, the Marketplace was made for you. For those that are looking for a plan just to cover basic needs and/or catastrophic events, they end up paying more for benefits they’ll never use. So prior to coverage year 2019, a 20 or 50 year old male would be penalized for not having coverage that covered birth control and breast feeding care; and yet, dental and vision coverage is not considered “Essential Health Benefits” for adults, so if either wanted dental or vision coverage, they then had to pay more, out of pocket to obtain it. That’s the same as being required to carry flood insurance in Arizona.
The good news is Americans are no longer required to have a Qualified Health Plan or face fees. The plans are still available for those who need them and that’s the beauty of the Marketplace: all of the plans found on the Marketplace are Qualified Health Plans.
So what if you don’t need all of that coverage and only want to pay for what you are going to use or where are you getting the best bang for your buck? Although most of what we hear today points consumers in the direction of the Marketplace for all of their healthcare needs, know that private insurers stood the test of time and have remained steady, happy to provide custom built coverage for the average American who does not need a Qualified Health Plan.
Carter Health Insurance has access to both Marketplace and Private plans; Contact us today to learn more about your options.