Key Takeaways
- The Affordable Care Act (ACA) open enrollment period is still ongoing, but premium increases and the expiration of enhanced tax subsidies have led to larger-than-expected costs for many Americans.
- Concerned shoppers are consulting insurance brokers or calling ACA marketplace call centers to explore their options.
- Short-term insurance plans, which are not ACA-compliant, may be less expensive but cover less and can exclude preexisting medical conditions.
- Bronze and catastrophic plans, which have lower premiums but high deductibles, may be more affordable options for those who want to stay with ACA plans.
- Shopping around and comparing different plans, including those offered by the same insurer, can help consumers find lower premiums.
Introduction to the Affordable Care Act
The Affordable Care Act (ACA) has been a vital source of health insurance for millions of Americans. However, with the open enrollment period still ongoing, many individuals are facing larger-than-expected costs due to premium increases and the expiration of enhanced tax subsidies. As a result, concerned shoppers are seeking advice from insurance brokers or calling ACA marketplace call centers to navigate their options. The Massachusetts Health Connector’s executive director, Audrey Morse Gasteier, notes that they are hearing from people with complex medical conditions who are worried about their access to medical care.
Short-Term Insurance Plans
Some ACA shoppers may consider short-term insurance plans sold outside the government-run marketplaces. However, these plans are not ACA-compliant and can be less comprehensive. They often require applicants to complete a medical questionnaire and can exclude coverage or cancel a policy retroactively for those with preexisting medical conditions. Additionally, short-term plans may not cover essential benefits such as preventive care, hospitalization, or emergency services. The Trump administration has sought to make these plans more widely available, but critics label them "junk insurance" due to their limitations. Insurance brokers recommend exercising caution when considering short-term plans, emphasizing that they are only suitable for healthy individuals.
Alternative Health Coverage Options
In addition to short-term plans, other types of health coverage are available, such as indemnity plans and faith-based sharing plans. Indemnity plans are meant to supplement traditional health insurance by paying toward deductibles or copayments, but they do not have to follow ACA coverage rules. Faith-based sharing plans, on the other hand, pool money from members to cover medical bills, but they are not required to keep financial reserves, and members are not guaranteed that their health expenses will be paid. These plans are often less expensive than ACA plans but may not provide comprehensive coverage. Experts advise consumers to carefully consider these options and understand their limitations before making a decision.
ACA Plan Options
For those who want to stay with ACA plans, the lowest premiums are generally found in the "catastrophic" or "bronze" categories. Bronze plans have lower premiums but high annual deductibles, which can average nearly $7,500 nationally. Catastrophic plans, which used to be limited to people under 30, are now available to those who lose subsidies due to the expiration of enhanced tax credits. These plans have high deductibles, up to the ACA’s annual limit on out-of-pocket spending, and may not be available in every region. Brokers recommend exploring these options, but also cautioning clients about the potential drawbacks, such as high deductibles that may be detrimental to those with limited incomes.
Shopping for ACA Plans
Shopping around and comparing different plans can help consumers find lower premiums. Some people may be able to find a lower premium by shifting to a different plan, even one offered by the same insurer. There are also different levels of coverage, from bronze to platinum, where premiums vary. Additionally, some individuals who run their own businesses with only one employee may qualify for a group plan rather than an individual policy, which can be less expensive in some cases. Experts encourage consumers to take preliminary steps, such as filling out or updating an application on the official federal or state marketplace website, to determine their options for the 2026 plan year.
Conclusion and Next Steps
As the deadline for choosing a health plan approaches, it is essential for consumers to carefully consider their options and seek advice from licensed brokers or counselors if needed. The official federal website, Healthcare.gov, can direct consumers to official ACA websites and licensed brokers who can help with the application process. Remembering to pay the first month’s premium for coverage to take effect is also crucial. By being informed and proactive, Americans can navigate the complexities of the ACA and find the best health insurance options for their needs and budgets.
