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What is the Affordable Care Act?

Doctor hand touching ACA (or AFFORDABLE CARE ACT) sign on virtual screen

The Affordable Care Act (ACA), officially called The Patient Protection and Affordable Care Act (PPACA) and sometimes called ObamaCare, is the US law that reformed both the healthcare and health insurance industries in America. The law increases the quality, availability, and affordability of private and public health insurance to over 44 million uninsured Americans through its many provisions, which include new regulations, taxes, mandates, and subsidies.

The law has 3 primary goals:

  • Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level (FPL). Note: If your income is above 400% FPL, you may still qualify for the premium tax credit in 2021.
  • Expand the Medicaid program to cover all adults with income below 138% of the FPL. (Not all states have expanded their Medicaid programs.)
  • Support innovative medical care delivery methods designed to lower the costs of health care generally.

On-Exchange vs. Off-Exchange Health Insurance Plans

The ObamaCare Health Insurance Exchange Marketplace opened Oct 1st, 2013. The ObamaCare health insurance exchanges, or ObamaCare exchanges, are online marketplaces for health insurance. Americans can use their state’s “Affordable” Insurance Exchange (marketplace) to obtain coverage from competing private health care providers. Shoppers can use a price calculator to see if they qualify for cost assistance subsidies (as well as Medicaid and CHIP) and see side-by-side comparisons of qualified health plans ensuring the best deal for them and their family.

An “off-exchange plan” refers to a health insurance policy that is not available for purchase within a federal or state exchange. An exchange is a government-run marketplace of health insurance plans. Both off and on-exchange health plans in the individual and small group markets must satisfy Essential Health Benefits coverage requirements and utilize one of the four “metal” plan designs (Bronze, Silver, Gold or Platinum) for medical out-of-pocket costs.

The Open Enrollment Period & New SEPs

Every year, people can shop for and enroll in new under-65 health plans on the marketplace during the Open Enrollment Period (OEP), which runs from November 1 to December 15, or during a Special Enrollment Period (SEP).

Your client may have an SEP if they’ve recently experienced any of the following:

  • Job loss
  • Moving to a new zip code
  • New child or death in the family
  • Coverage loss
  • Marriage/divorce
  • Citizenship status change
  • Government error
  • Change in subsidy eligibility
  • Qualifying federal reason

For 2022, a couple new Special Enrollment Period opportunities will be available to your clients. There will be one for individuals who did not receive timely notice about a qualifying event and another for those who lose employer contributions or government subsidies for continued employer health coverage under COBRA.

To take advantage of an SEP, you and your clients must act within 60 days of the qualifying life event. Currently, there’s a federal SEP in place for everyone in the U.S. to buy or switch marketplace plans. This SEP started February 15, 2021, and runs through August 15, 2021.

The Agent Advantage

You may know that navigators are also available to help individuals find and enroll in on-exchange plans. However, there’s a big difference between navigators and agents or brokers like you: Navigators cannot recommend one plan over another.

Health insurance marketplace navigators cannot recommend one plan over another — but you can!

You can help your clients understand the best plans for them based on their needs. By getting involved in this market, you’re looking out for the best interest of your clients, and yours as well! Under-65 sales can increase your bottom line and keep your book of business booming for years to come!

Get Started Today

The ACA health market has seen a lot of changes within the past few years, especially this past one. Here at MCC Brokerage, we’re embracing the amazing sales opportunities that the ACA and American Rescue Plan Act present. We’ve jumped back into the marketplace, and we hope you’ll join us in selling under-65 plans! If you would like to learn more about how you can grow your revenue and fill your T65 pipeline for future Medicare plans by offering ACA coverage to your clients,  contact us today.

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