Non-Obamacare plans are an affordable alternative for people that want health insurance for an unexpected illness or injury, but can’t afford a 2017 Affordable Care Act (ACA) / "Obamacare" plan. If you’re healthy and don’t need coverage for maternity, mental health, substance abuse, or a pre-existing condition, then a Non-Obamacare plan may be your best choice.
Large national Aetna Open Choice PPO and United Health Care PPO networks with access to more doctors & hospitals
Affordable monthly premiums
Up to $1.5 Million in coverage per year
Variety of deductible and out of pocket choices
Doctor Visits and some preventive care
Emergency room and ambulance coverage
Hospitalization and surgical coverage
Critical illness and accident coverage
Urgent care benefits, and more
The Affordable Care Act (ACA) / "Obamacare" plans provide coverage for all pre-existing conditions from day 1, without any lifetime or yearly limits for Essential Health Benefits. If you’re going to receive medical care and/or prescriptions for a condition you need the insurance company to pay for, or if you qualify for a large tax credit subsidy to help pay for your coverage, then an ACA/Obamacare plan is probably your best choice. Remember, even though an ACA/Obamacare plan will cover all pre-existing conditions from day 1, you must satisfy/meet your deductible or copay before the insurance company will pay benefits.
Guaranteed acceptance during annual Open Enrollment period from November 1st through January 31st
Day 1 coverage for pre-existing conditions to pay for the care your receiving now or that is already scheduled
Subsidies and cost share allowances available for low income households
No lifetime or yearly limits for Essential Health Benefits
May have a limited choice of plans, doctors and hospitals depending on your area
Expensive for people without subsidies or cost share allowances
Most people get their health insurance through an employee group health plan at work. Nearly all employee group plans qualify as Minimum Essential Coverage (MEC), and as a result employees are not subject to the Obamacare penalty.
Employee group health insurance provides an employer the ability to offer its employees a tax-deductible health insurance option that usually offers better access to doctors and hospitals than the plans on the government marketplace. Rather than the employee receiving premium assistance with a tax subsidy from the government, the employee receives a contribution from the employer plus a tax-deduction to reduce the monthly premium.
Large national Aetna Open Choice PPO, PHCS PPO, and United Health Care PPO networks with access to more doctors & hospitals
Tax-deductible premium for employer AND employee
Customizable plan design to fit employee needs and budget
No penalty - compliant with the Affordable Care Act (ACA) and Minimum Essential Coverage rules.
The Affordable Care Act (ACA) / "Obamacare" determines who gets tax subsidies, penalties and exemptions. Which category you fit in will most likely determine which path you take for the 2017 plan year.
Advanced Premium Tax Credit (APTC) - provides a subsidy that will pay a portion of the premium for low income households
Cost Share Reduction (CSR) - provides lower deductible and copays for low income households
Shared Responsibility Payment - mandates a fee, also known as a "penalty" or "fine" for not having an ACA/Obamacare plan
Code "A" Coverage Exemption - provides an exemption to the penalty if the least expensive ACA/Obamacare plan is more than 8.13% of your income
Ministry Health Sharing - provides an exemption to the penalty for members of a qualified health sharing ministry