It has never been easier for low-income households to afford health insurance thanks to the Affordable Care Act. This act provides affordable health insurance services to individuals and households, including those whose incomes are around the federal poverty level. The system makes health insurance accessible to everyone.
You can sign up for your ACA plan during the open enrollment period. This period starts around the late part of the calendar year. For the 2025 coverage period, open enrollment starts on November 1, 2024, and goes until December 15. People also have until January 15, 2025, to enroll in or change their plans for the year starting February 1.
The benefits you’ll get through your ACA setup are plentiful, plus you might not have to spend anything on monthly premiums. But you will still have to pay for certain medical services, so looking at what goes into your ACA plan is necessary.
You’ll also receive support from many of the country’s top service providers. These include many local and national healthcare service teams ready to help you with your medical care and preventative service needs.
Low-income households can significantly benefit from the Affordable Care Act because it provides coverage for various health-related needs. You will receive coverage for various medical services and needs through your plan, including these points:
You’ll be able to afford healthcare through your ACA plan, plus you won’t have limits on how much coverage you’ll receive in one year.
You’ll receive access to your plan through tax credits that will reduce the total of your monthly premium. Depending on the program you use and what you qualify for, you could get your policy with no premiums.
Before you start looking for ACA plans, you have to see if you qualify for them first. There are a few ACA qualification standards you’ll have to meet at the start:
The application process takes a few minutes and is clearly labeled. But be sure before you sign up that you have access to all your financial data so you can get a more accurate report on what you can qualify for when getting a plan.
Don’t worry about being rejected for an ACA plan because of a pre-existing condition in your household. The ACA states that health insurance providers cannot refuse coverage to you or charge you extra because you or another household member has a pre-existing condition.
A pre-existing condition is a medical issue someone has prior to receiving health insurance coverage. Diabetes and asthma are among the more common ones, but various cancers also qualify. Pregnancies are also considered pre-existing conditions.
Pre-existing condition care will be available in your ACA plan. You won’t be turned down for it, and you won’t experience substantial benefit limits either.
You will provide various pieces of information in your ACA application, including info on your income, assets, household situation, and any healthcare politics you might have with an employer. The ACA application portal can review your situation and determine your eligibility for a plan.
You’ll receive information on the premium tax credit you will receive for your coverage. The credit is a monthly total you will receive to offset the cost of whatever healthcare plan you choose.
Information on your healthcare providers will also be necessary. You can list info on whatever practitioners you will use and the medications you’ll require. You can see in each plan you review whether those people and drugs are covered in a plan. The ACA website also lets you check on individual networks to see if there are any doctors near you who would qualify for a plan that interests you.
You should also include information on anyone in your household when getting your plan ready. This point is particularly valid for families with young children. When you apply for your ACA plan, you're also looking at your dependents and how they can benefit from whatever plan you use.
While your tax credit will keep you from spending hundreds of dollars each month on health insurance premiums, you’ll still have to pay specific amounts based on what services you use. You’ll have to consider these potential expenses based on your current health situation and what needs may arise.
Here are a few of the typical costs that you may end up covering:
Your deductible is the amount of money you’d have to spend on medical services before the insurance policy starts paying for things. The deductible can be worth thousands of dollars.
Your policy can still cover various expenses even if you haven’t met the deductible. Preventive care services are the most common ones that are automatically covered.
Depending on your plan, you might also not have to meet a deductible for your insurance coverage to pay for something.
A copay is the maximum amount of money you will spend on a service. For example, a plan might have a $40 copay for when you visit a primary care center. In this case, you would pay $40, and the insurance company will cover the rest.
Coinsurance is the portion of what you would pay for a medical service. For example, you might have a 40 percent coinsurance on something in your policy. In this case, you would pay 40 percent of the expense, and the insurer would pay the remaining 60 percent.
Your ACA plan will work within a particular network of service providers. You will likely spend more money on out-of-network costs involving providers who are not within your selected plan’s network. These added expenses may be waived if you need to see someone for emergency purposes.
All these terms will influence what you would spend on medical services through your policy. Be sure to look at different policies to see what’s open.
You will find various different plans when searching for ACA options, and you’ll notice four particular choices. Here’s a look at these four options:
A Preferred Provider Organization or PPO plan lets you visit various in-network providers without requiring any referrals from a primary care specialist. An average PPO plan requires you to pay your annual deductible before the insurer can cover most services.
An HMO requires you to choose a specific primary care physician who will cover most of your healthcare needs and can refer you to specialists as necessary. HMO plans have lower monthly premiums and minimal deductibles and are best for people who mainly require preventative health services. You will likely have to spend your own money for non-emergency out-of-network costs.
You can also consider an Exclusive Provider Organization or EPO where you will only use the healthcare providers within a network. Referrals are not required, and you’ll enjoy lower monthly premiums. This option works if you don’t need to use people outside a network.
A Point of Service plan or POS can also work. This option works like a combination of an HMO and PPO. You will select a specific primary care physician who can make referrals to in-network specialists. This option works when you aim to coordinate your care through whatever physician you prefer.
Be sure you consider your general needs for care when finding a program that works for you.
One noteworthy point in your ACA plans is the metal rating. The marketplace for ACA plans typically places each plan in one of four metal levels.
The bronze category provides the least expensive premiums, but you’ll also spend more for whatever services you use. The deductible is typically high, and you will likely pay about 40 to 50 percent of covered services, with the insurer paying the rest.
The premiums for a silver plan are lower, and you could spend about 30 to 40 percent of expenses. You could qualify for additional savings depending on who you contact. If you can receive extra savings, you could spend as little as 10 percent.
A gold plan has a low deductible and can request a payment of about 20 percent, but the monthly premium will be more expensive.
Platinum plans are mainly for those with regular medical needs. These have the costliest premiums, but the out-of-pocket payments you’d spend are minimal.
Low-income households will typically require a bronze plan because it has lower or no monthly premiums, but be sure when comparing plans that you review the approximate cost for use based on whatever medical needs you may hold.
Households with limited incomes can qualify for a fifth plan category, the catastrophic plan. A catastrophic plan is available to people who have affordability exemptions. Specifically, you can qualify if the lowest-priced coverage available through the ACA marketplace or your employer costs at least 7.97 percent of your annual household income.
A catastrophic plan has lower monthly premiums, but they also have higher deductibles. This option is best for when you need help protecting yourself if any worst-case scenarios ever occur.
However, a bronze or silver plan may be more appropriate if you have more frequent medical needs or can get enough tax credits. Check on your income when reporting it to confirm that you can afford a bronze or silver plan before going after a catastrophic plan.
Affordable Care Act plans are available for low-income households who need help affording health insurance. It is easy for people to receive help for their healthcare expenses, as they can qualify for insurance policies with little to no monthly premiums. But be sure when checking different options that you’re working with a plan that fits your needs.
Compare choices to see how the networks work, and look at the potential expenses associated with whatever you may find. Take note of your current medical needs and what you may require for treatment. Remember that you won’t be turned down for anything because of any pre-existing conditions you hold.