ACA - Griffin Insurance Solutions

Affordable Care Act (ACA)

If you think you can’t afford good health insurance, you haven’t talked to us! We make shopping for Health insurance Easy, Understandable, and Stress Free! If you are over 65 with Medicare plans or under 65 we can help!

What is the Affordable Care Act

The Affordable Care Act known (ACA) colloquially as Obamacare was a comprehensive reform law, enacted in 2010, that increases health insurance coverage for the uninsured and implements reforms to the health insurance market. This includes many provisions that are consistent with AMA policy and holds the potential for a better health care system.

The healthcare law known as ACA (Obamacare) has undergone a number of changes.

Perhaps the most significant change made to the ACA is the elimination of what is known as the individual mandate. Prior to 2019, you could face large tax penalties if you were uninsured. The federal tax penalty no longer exists.

Under the Affordable Care Act, patients who may have been uninsured due to preexisting conditions or limited finances can secure affordable health plans through the health insurance marketplace in their state.

Pros and Cons of the Affordable Care Act

To help you make the best decision on your healthcare it is important to weigh both sides of the ongoing debate, here are a few of the often-debated Affordable Care Act pros and cons.

Pros of the Affordable Care Act:

Carrier Selection is Expanding and Adding Additional Networks

In most markets carrier sections has been expanding the last few of years. This is why it is important to deal with an Independent Agency such as Griffin Insurance Solutions because we keep up with the changing Marketplace and add these new Insurance Companies to our portfolio of options.

Government incentives offer financial help

Government incentives make purchasing health insurance less expensive for those who qualify for subsidies. Generally subsidies are available for households making less than 400% of the Federal Poverty Level (FPL). Additionally, the Inflation Reduction Act, that was recently passed in August of 2022, extends the enhanced subsidies for people buying health insurance through the Marketplace through 2025. Also, the implementation of the 80/20 rule means 80% of your premium dollars is spent on healthcare instead of administrative costs.

In addition to subsidies offered to households making less than 400% FPL, for families making less than 250% FPL, they can qualify for Cost Sharing Reduction (CSR).  A CSR, is a discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance.

Lowest eligible income for ACA CSR Tier 1 limit CSR Tier 2 limit CSR Tier 3 limit CSR Tier 4 limit CSR Tier 5 limit

Family Size

100% FPL

150% FPL

200% FPL

250% FPL

300% FPL

400% FPL

1

$12,880

$19,320

$25,760

$32,200

$38,640

$51,520

2

$17,240

$26,130

$34,480

$43,550

$52,260

$69,680

3

$21,960

$32,940

$43,920

$54,900

$65,880

$87,840

4

$26,500

$39,750

$53,000

$66,250

$79,500

$106,000

5

$31,040

$46,560

$62,080

$77,600

$93,120

$124,160

6

$35,580

$49,100

$53,370

$88,950

$106,740

$142,320

Each Additional

$4,540

$6,810

$9,080

$11,350

$13,620

$18,160

Preventive care

All qualified health insurance plans must provide 10 essential health benefits. These benefits include preventive care and wellness visits with no copay, deductible, or coinsurance.

No pre-existing condition denials

Insurance companies also cannot deny coverage for a pre-existing condition.

Medicaid is more inclusive for many

For states that have chosen to expand their program, Medicaid coverage now includes uninsured Americans under 138% of the federal poverty level.

Dependents can stay under parents’ ACA plan longer

Your children can be insured under your health plan until they are 26 years old.

Stable ACA Networks

Originally many insurance companies made their provider networks smaller to cut costs while implementing ACA requirements.

This trend however is stabilizing as we are starting to see some doctors re-enter the ACA Networks now that they have been around for over 12 years. This trend is also getting better due to additional Carriers entering the Marketplace as well that bring along additional Networks as well.

No more ACA limits

Limits on lifetime benefits have been completely banned and annual limits phased out. (This does not include grandfathered plans).

Cons of the Affordable Care Act:

The cost has not decreased for everyone

Those who do not qualify for subsidies or make over the 400% FPL may find marketplace health insurance plans unaffordable. Customers may end up paying more for a plan that includes benefits, such as maternity care, that they may not need. Do to these increases in price, these individuals may need to discuss other “Off Market” Health Insurance options with us. The term Off Market, just means these are plans are not available for subsidies, but also don’t have to abide by all of the ACA rules. These off market plans will sometimes lower premiums by asking health questions or not always covering pre-existing conditions. However, if you don’t have preexisting conditions and can qualify, they can sometimes be more affordable.

Loss of company-sponsored health plans

Some businesses may find it more cost-effective to let their employees purchase their own individual insurance on the exchanges rather than provide employer-sponsored coverage.

Shopping for coverage can be complicated

Shopping for coverage can be complicated with limited enrollment periods, difficulties with the websites, and more coverage options. Additionally with so many new carriers entering the Marketplace, it is important to shop your options with a reputable Independent Broker such as Griffin Insurance Solutions since we stay up to date with all the new plans and changes.

Regardless of the Affordable Care Act pros and cons, Griffin Insurance Solutions can be your helping hand in figuring out your health insurance options.

Call us today at 919-704-6147 or 800-774-1434 to talk with a licensed insurance agent.

We have been helping people across North Carolina and beyond with their ACA and Medicare needs for almost 10 years. Nobody knows more about health insurance than Griffin Insurance Solutions. Our expert service costs you nothing.

●  We get you the same price you would get even after you spend hours researching your choices.

●  We often save you money, because we make sure you get the right plan for your individual needs.

●  We provide proof you actually enrolled.

●  We take the time to make sure you really understand the plan you are signing up for.

Frequently Asked Questions:

The “Affordable Care Act” (ACA) is the name for the comprehensive health care reform law and its amendments. The law addresses health insurance coverage, health care costs, and preventive care.

Individuals at all income levels can sign up for health insurance under the Affordable Care Act. If you have a household income between 100% and 400% of the federal poverty level (FPL), you probably qualify for a premium tax credit or special subsidies that will reduce health insurance costs as long as you don’t qualify for any other affordable Health Insurance options.

No. Since its inception way back in 2010 there have been many material changes to the “Affordable Care Act” (ACA). Today’s ACA has matured into a coverage benefiting millions of Americans without fear of penalties or exclusions.

In the simplest terms, the main difference between understanding Medicare and “Affordable Care Act” (ACA) is that the ACA refers to private health plans available through the Health Insurance Marketplace mainly for those under 65 year of age. While Original Medicare is provided through the federal government and mainly for those over 65, on Medicare Disability, or receiving Dialysis.

No. The Marketplace doesn’t affect your Medicare choices or benefits, so if you have Medicare coverage, you don’t need to do anything. This means no matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan (like an HMO or PPO), you don’t have to make any changes.

No, technically you just lose the subsidy and the ACA plans don’t cancel automatically. Medicare is the better choice for anyone who qualifies for free Medicare Part A (40 working quarters).

If you don’t qualify for Free Medicare Part A, then you still have the option to apply for ACA and subsidy.