Full Coverage insurance for people who reside in the United States
What is Obamacare?
Unlike what many think, Obamacare is not a government offered health insurance. It is a nickname given to a law (ACA – Affordable Care Act) which regulates full coverage health insurance in the US.
This law requires that the insurance companies provide one free annual checkup, that they cover illnesses – even pre-existing ones, that it covers emergencies, surgeries, maternity care, amongst other health needs without limit of coverage.
Coverage for all illnesses
Individual and Family insurance
Accessible plans to all
Annual application every November-December
How does Health Insurance work in the US?
Your health plan is a contract between you and the insurance company you choose. When you purchase a plan, the insurance company agrees in paying part of your health costs, which varies according to each specific plan. The plans offered by the Marketplace provide free preventive care, such as vaccines and the annual checkup. They also may cover a portion of prescription medicine.
How will Health Insurance help me with medical services?
Did you know the average cost of a three day hospital stay is US$ 30,000? Or that a broken leg might cost around US$ 7,500 to take care of? Having health insurance can help you protect yourself from unexpectedly high cost health bills like these. In the Summary of Benefits of your plan you will be able to check your coverage by type of care, treatments, services, as well as your costs versus the company’s costs.
How should I prepare?
Be sure to understand how your plan works – premiums, deductibles, out of pocket, copayments, and coinsurance. These terms will come in handy when picking and using your plan.
What are the types of coverage in Health Insurance?
Through the Marketplace you will be able to pick a plan with good balance between cost and coverage. By getting familiar with health terms and usage before using the plan, you should have no issues. Make a list of questions before picking your health plan. For example: “Can I keep going to Dr Jones?”, “Can I keep taking this medicine?”, or “Will I be covered when I travel?” It is ideal to ask questions before defining a plan.
When comparing Marketplace plans, have in mind they are divided into four categories and the category you fall under will change according to factors such as what you expect from the company, how much the company is willing to cover, and even your household setup. The categories are Silver, Bronze, Gold, and Platinum.
What will my expenses be with Health Insurance?
Usually you pay a monthly amount (premium) just to have coverage and access to your health plan. You might also have to pay a yearly deductible before the company starts sharing costs, depending on which plan you choose. Besides that, you will also have a copayment for whenever you need to have a service done.
The cost of the monthly fee is just as important as how much you have to pay when using the services.
- Deductible: what you pay before the company starts sharing costs
- Coinsurance: what you pay after the company starts sharing costs. Copay: preset amounts you pay each time you need a certain service
- Out of Pocket: the maximum amount you will pay during the year with all services combined, as long as you use in-network providers
What the policy covers is usually directly related to the price of the health insurance policy. The policy with the lowest monthly fee may not cover many services and treatments.
How it works? Is everything included with the premium?
No. There will be other costs such as copay, coinsurance, deductible, out of pocket…
There is no full coverage health insurance in which you pay only a monthly premium and services are all free/included. Only after you reach your plan’s out of pocket the company will cover 100% of your services for the year, however you will still need to pay your monthly premium.
My friend has a family as big as mine, they live near me, but they pay considerably less. Why?
The premiums are calculated through a tool that takes into consideration age, gender, number of members in the family, zip code, county, and most importantly, estimated household annual income. Families with lower income receive more Tax Credit, and so their premiums are usually lower. Families with higher income receive less Tax Credit, and so their premiums are usually higher as well.
How do I pick the best plan for my family?
When comparing Marketplace plans, have in mind they are divided into four categories and the category you fall under will change according to factors such as what you expect from the company, how much the company is willing to cover, and even your household setup. The categories are Silver, Bronze, Gold, and Platinum. Silver plans, for those who qualify, get “Extra Savings” meaning they have smaller copays and out of pockets. You may qualify if your household is under the poverty line by 200%.
The category you choose will influence premium, copay, deductible, and out of pocket however it will not influence at all in the quality of care, quantity of service, or coverage limit.
Equilibrium between monthly premium and service costs
Like in any health plan, you will have a monthly premium. Usually the Gold and Platinum categories have higher premiums than Silver and Bronze, but their copays are smaller. In a Bronze plan you would have a cheaper premium than Gold or Platinum, put the copays would be bigger. In a Silver plan, if you qualify for Extra Savings, you would have smaller premiums and smaller copays.
In general when picking a plan think that if the premium is low, the copays will be high. If the premium is high, the copays will be low.
What is the best option for those who need many services, procedures, treatments, and drugs?
If you are going to need to use the plan a lot and do not qualify for a Silver category, it might be worth considering a Gold or Platinum plan. Their premium might be a bit more expensive, but their copays and out of pocket will be less than the Bronze plans
Evaluate your options
The majority of people who are eligible to get a Marketplace plan are also eligible to receive Tax Credit, a government incentive that makes premiums more affordable. This incentive is directly related to the family’s income tax and is calculated according to each household. To know how much Tax Credit you and your family could receive, please have the following ready:
- Social security of all members
- Date of birth
- Paycheck, W2, or 1040
- Information about health insurance you or your family might have been offered through work
Can I purchase Obamacare at any time?
No. As per the American government’s determination, this Full Coverage insurance may only be purchased during two times of the year. During the Open Enrollment Period (OEP) from November 1st to December 15th, in which case your coverage would start on January 1st of the following year with no waiting periods. Or during a Special Enrollment Period (SEP), which would be within 60 days of a life changing event, such as: birth/adoption of a child, loss of coverage through work provided insurance, loss of coverage through Medicaid, change in immigration status, moving from another country to the US, and more. If you want to know whether your particular situation would be eligible for an SEP, please contact us.
I have a valid immigration status, but I do not have proof of income. Can I get Obamacare?
Yes. You can get Obamacare paying full price, so you would not need proof of income in this case. You can also provide a Self Employment Ledger in which you would claim and sign that you expect to have that income by the end of the year even though you do not have it at all the moment of your application. If you work for a company, you can provide a letter from the company or your last paystubs.
Why would I choose Obamacare over Short Term?
With an Obamacare insurance, the insurance companies cannot deny coverage or overcharge you based on a pre-existing condition, they cannot limit your coverage for services, they are mandated to cover preventive services, and so on.
I already have Obamacare. When should I reapply? Can I purchase Obamacare at any time?
If you already have Obamacare, you should consider reapplying during Open Enrollment Period, from November 1st to December 15th. This way you can see if there are any better options for the following year. If you do not reapply, you will be automatically renewed into the current year’s plan, which is not always the cheapest or most beneficial option. Call us for more information (407) 502-0203 After the OEP, you would only be allowed to change plans if you were eligible for a SEP. These SEPs are a change of immigration status, a marriage, loss of work or student insurance, etc. Call us for more information (407) 502-0203
How much is Obamacare?
Your estimated premium will vary according to a few factors, such as:
- Household setup
- Residential address
- Estimated household annual income
- Plan category and characteristics
Is Obamacare like SUS in Brazil?
No. When you enroll in Obamacare you are purchasing a plan from a private company, which has to follow governmental laws. It is not a plan offered by the government and it is not a Public Charge.
What is a "Health Insurance Marketplace"?
The Marketplace is a platform where you can sign up for ACA plans (Obamacare).
What should I do before consulting the Marketplace?
Before starting your Marketplace application you should gather as much information as possible, as complete and accurate as possible, and contact an agent/broker licensed by the State you live in, who will help you for free. By law, agents and brokers should provide free service, charging nothing of the client.
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Through this decade working with insurance we learned that every person must be treated as an individual and you are of the utmost importance to us. That is the reason we choose to offer a personalized service and are constantly searching to provide the most viable solutions.
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