1. ACA (Major Medical) - A Full Picture
The Affordable Care Act was signed in 2010. It created state-based Marketplaces where individuals can purchase health insurance with essential health benefits. Here is what you need to know:
What ACA Plans Include
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10 essential health benefits: hospitalization, prescription drugs, maternity care, mental health, preventive care, and more
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Guaranteed issue: Insurers cannot deny coverage based on pre-existing conditions
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No lifetime limits on coverage
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Premium tax credits (subsidies) for households earning 100–400% of the federal poverty level
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Open enrollment is annual (typically November–January); outside of this, a qualifying life event is required
ACA Pros
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Comprehensive coverage — especially valuable for clients with chronic conditions or complex medical needs
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Subsidies can make premiums very low or even $0/month for qualifying households
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No underwriting — anyone can enroll regardless of health history
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Out-of-pocket maximums cap catastrophic costs
ACA Cons
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Unsubsidized premiums are expensive: $400–$1,200/month for an individual, $800–$2,500/month for a family
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Narrow networks: 53% of Marketplace plans have limited provider networks (McKinsey) — clients lose their doctors
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High deductibles: Bronze and Silver plans often have $6,000–$12,000 deductibles
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Complex enrollment and billing — surprise bills are common
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Premium cliffs: Clients earning just above subsidy thresholds get hit hard
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Your Sweet Spot A client earning $80,000/year as a self-employed individual gets no subsidy and faces $700+/month premiums for a narrow-network plan with a $6,000 deductible. That is exactly who we help. |