ACA Plans
Affordable Care Act (ACA) plans are compliant with federal law and provide many health benefits. Let’s break down these plans to better understand what they are and how they work.
What are ACA Plans?
The Affordable Care Act (ACA) was enacted by past President Obama in 2010. Generally, it was established to lower healthcare costs and provide health insurance to more individuals who may not have had access to quality, inexpensive healthcare otherwise.
Generally, ACA plans meet a few specific guidelines:
- No annual or lifetime coverage maximums.
- Guaranteed issue during open enrollment. Guaranteed issue means that you may receive coverage regardless of health, age, or wealth. Open enrollment takes place between October 7th to December 15th.
And, these plans offer 10 basic services:
- Provide hospitalization coverage.
- Ambulatory services.
- Emergency services.
- Maternity/newborn care.
- Mental health and substance abuse treatment.
- Prescription drug coverage, including brand name and specialty drugs.
- Lab test services.
- Preventative services.
- Pediatric services (including dental and vision).
- Therapeutic care, i.e. rehabilitative and “habilitative” services including helping a person keep, learn, or improve functioning for daily living.
4 Common ACA Plans
There are 4 common ACA plans:
- PPOs – or Preferred Provider Organization Plans
- POSs – or Point-Of-Service Plans
- HMOs – or Health Maintenance Organization Plans
- EPOs – or Exclusive Provider Organization Plans
Each of these plans meets the same guidelines and offer the 10 basic benefits described above, all of which are universal to ACA plans. However, each plan varies in how these benefits are provided. This is how the cost changes between individual plans—some offer more coverage in certain areas than others, some less, etc.
PPOs offer a network of healthcare providers at a lower cost than that out-of-network. However, compared to other plans, this plan is fairly flexible, allowing you to receive care from virtually any healthcare provider of your choice.
HMOs, on the other hand, rely more heavily on this network of providers. You will have to choose a primary care physician, and get a referral from them to seek specialist or out-of-network care. These plans also have lower out-of-pocket costs and deductibles than PPOs.
POSs are a “middle ground” between PPOs and HMOs. You will have to choose a primary care physician and receive referrals for specialist care, similar to an HMO plan. Similar to PPOs, however, you can seek out-of-network care for a higher out-of-pocket cost if you so choose.
Finally, EPOs work solely within a set care network. Unlike the other plans, you must receive all of your care from within this network. So, if the provider in your area has a network that includes your preferred healthcare providers, and for a lower monthly premium than any of the other plans without needing specialist referral, this plan may be right for you.
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Your Health Insurance is Important to Us—Call Veritas Insurance Group for Expert Guidance
ACA plans are a secure option for many individuals. We can help you determine which plan is right for you, and help you find the best providers in your area. If you are ready to get started, call Veritas Insurance Group at 563-940-2284.
