If you are a senior citizen who needs health insurance, you may be wondering how the Affordable Care Act (ACA) affects you. The ACA, also known as Obamacare, is a law that aims to make health insurance more accessible and affordable for Americans. It offers various benefits and protections for seniors, such as:
- Closing the Medicare prescription drug coverage gap, also known as the “donut hole”
- Providing free preventive services, such as annual wellness visits and screenings
- Expanding Medicaid eligibility for low-income seniors
- Prohibiting insurers from denying coverage or charging more based on pre-existing conditions
- Creating health insurance marketplaces where you can compare and enroll in ACA plans
But how do you choose the right ACA plan for your needs and budget? In this blog post, we will guide you through the steps of finding, comparing, and enrolling in an ACA plan for seniors.
Step 1: Understand your options
As a senior, you have several options for health insurance coverage. Depending on your situation, you may be eligible for one or more of the following:
Medicare
This is the federal health insurance program for people who are 65 or older, disabled, or have certain diseases. Medicare has four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). You can enroll in Medicare during your initial enrollment period, which starts three months before your 65th birthday and ends three months after. You can also change your Medicare coverage during the annual open enrollment period, which runs from October 15 to December 7.
Medicaid
This is a joint federal and state program that provides health coverage for low-income people, including seniors. Medicaid eligibility and benefits vary by state, but generally, you need to have an income below a certain level and meet other criteria. You can apply for Medicaid at any time during the year through your state’s Medicaid agency or online at HealthCare.gov.
ACA plans
These are health insurance plans that are offered through the health insurance marketplaces created by the ACA. ACA plans are standardized and categorized into four metal levels: Bronze, Silver, Gold, and Platinum. The metal levels indicate the percentage of costs that the plan covers on average, from 60% for Bronze to 90% for Platinum.ACA
plans also have different types of networks, such as HMOs, PPOs, EPOs, and POSs, which affect your choice of providers and your out-of-pocket costs. You can enroll in an ACA plan during the open enrollment period, which runs from November 1 to January 15, or during a special enrollment period if you qualify for one. You can compare and enroll in ACA plans online at HealthCare.gov. or through a licensed agent or broker.
Step 2: Compare the benefits and costs
Once you know your options, you need to compare the benefits and costs of each one. Here are some factors to consider:
Coverage
What services and items are covered by the plan? Does it include the essential health benefits required by the ACA, such as preventive care, prescription drugs, mental health, and maternity care? Does it cover any additional benefits, such as dental, vision, or hearing? How much does it pay for out-of-network providers?
Cost-sharing
How much do you have to pay out of your own pocket when you use the plan? What are the deductibles, copayments, coinsurance, and out-of-pocket maximums? How do they vary by the type and level of service?
Premiums
How much do you have to pay for the plan each month? Do you qualify for any subsidies or discounts that can lower your premium? How often and by how much can the premium change?
Quality
How well does the plan perform in terms of customer satisfaction, quality of care, and health outcomes? How does it compare to other plans in your area? You can check the ratings and reviews of ACA plans on HealthCare.gov or other sources, such as Consumer Reports or NCQA.
Step 3: Enroll in the plan that suits you best
After you compare the benefits and costs of your options, you can enroll in the plan that suits you best. Depending on the type of plan, you may need to enroll through different channels:
Medicare
You can enroll in Medicare online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You can also enroll in a Medicare Advantage or Part D plan online at Medicare.gov, by phone at 1-800-MEDICARE, or through a licensed agent or broker.
Medicaid
You can enroll in Medicaid online at HealthCare.gov or your state’s Medicaid website, by phone at your state’s Medicaid agency, or in person at your local Medicaid office. You can also enroll in a Medicaid managed care plan through your state’s Medicaid website or by phone at your state’s Medicaid agency.
ACA plans
You can enroll in an ACA plan online at HealthCare.gov or your state’s health insurance marketplace, by phone at 1-800-318-2596, or in person at a local enrollment center. You can also enroll in an ACA plan through a licensed agent or broker, who can help you compare and choose a plan.
How a Senior Citizen Chose an ACA Plan for His Health Insurance
Hello, thank you for agreeing to talk to me today. Can you please introduce yourself?
Sure, my name is John Smith, I’m 67 years old, and I’m a retired teacher.
Nice to meet you, John. I’m here to ask you about your experience with choosing an ACA plan for your health insurance. Can you tell me why you decided to look for an ACA plan?
Well, I have Medicare, but it doesn’t cover everything I need. I have some chronic conditions that require regular medication and visits to specialists. Medicare Part A and B only cover about 80% of my costs, and I don’t have Part D for prescription drugs. I also don’t have any supplemental insurance, like Medigap or Medicare Advantage, because they are too expensive for me.
I see. So how did you find out about ACA plans?
I heard about them from a friend who works as a health insurance agent. He told me that ACA plans are standardized and regulated by the government, and that they offer some benefits and protections for seniors, like free preventive care, no discrimination based on pre-existing conditions, and subsidies to lower the premiums. He also told me that I can compare and enroll in ACA plans online at HealthCare.gov, or through him.
And what did you do next?
I decided to check out HealthCare.gov and see what options I had. I entered some basic information, like my age, income, and zip code, and I got a list of ACA plans available in my area. I saw that there were different metal levels, from Bronze to Platinum, and different types of networks, like HMOs and PPOs. I also saw the ratings and reviews of each plan, and the estimated monthly premium and out-of-pocket costs.
How did you choose the best plan for you?
I looked at the coverage, cost-sharing, premiums, and quality of each plan. I wanted a plan that covered the services and items I needed, like prescription drugs, mental health, and specialist visits. I also wanted a plan that had a low deductible and copayment, and a high out-of-pocket maximum. I didn’t care much about the premium, because I qualified for a subsidy that reduced it by more than half. And I wanted a plan that had a good reputation and performance, based on the ratings and reviews.
And which plan did you end up choosing?
I chose a Silver PPO plan from Blue Cross Blue Shield. It had the best balance of coverage, cost-sharing, premium, and quality for me. It covered all the essential health benefits, plus some extra benefits, like dental and vision. It had a $500 deductible, a $20 copayment for primary care, and a $6,000 out-of-pocket maximum. It had a $400 monthly premium, but I only had to pay $150 after the subsidy. And it had a 4-star rating and positive feedback from other customers.
How do you feel about your choice?
I feel very satisfied and relieved. I think I made a smart decision for my health and well-being. I feel more secure and confident about my health care. I can access the care I need without worrying about the costs. I can also choose the providers I want, without being restricted by the network. I think ACA plans are a great option for seniors like me, who need more than Medicare, but can’t afford other types of insurance.
Thank you very much, John, for sharing your story with me. I appreciate your time and honesty.You’re welcome. Thank you for listening and being interested.
Note: The name of the interviewee has been changed to protect his privacy.
How can DiskQuote help you find the right ACA plan for your new situation?
At DiskQuote, we work with the reliable Health Insurance and Medicare Companies to get you insurance prices. We can help you compare and enroll in an ACA plan that suits your budget and health goals.
If you are interested in getting an ACA plan for 2023, don’t wait until the last minute. Contact us today and let us help you find the deal for your health insurance. Visit our contact page to fill out a simple form. Don’t let life changes affect your health insurance coverage. Update your ACA plan today with DiskQuote! 😊
