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On-Exchange Health Insurance MarketPlace ObamaCare FL

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On-Exchange health insurance plans are for people that qualify for an ObamaCare MarketPlace Subsidy, which is based on your household income and size. After determining your Subsidy, there are 49 plans offered in Jacksonville Florida or Duval County with different premiums, provider networks and plan benefits. When trying to decipher your “best option” via the internet remember price is only one of the key components. You should check the provider networks for your doctors and hospitals plus consider plan coinsurance, copays and deductibles. So, unless you are insurance savvy and computer efficient comparing can be a daunting task. It is much easier and secure to let us do the free research for YOUR 3Rs *** Right Doctors, Right Coverage, Right Price!

The Annual Open Enrollment for 2016 Qualified ACA Plans ended January 31, however, you may qualify through a Triggering Event for a Special Enrollment and you will have 60 days to apply: 1) Gain Dependent 2) Gain Citizenship 3) Loss Group Coverage 4) Move New Area.  These are the main Triggers but there are other opening Events so contact us for your eligibility questions.

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CAUTION – If you buy a Non-Qualified Health Plan you are subject to a Penalty because the policy does not meet ACA requirements, does not cover pre-existing conditions, and has limited benefits.

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Average Premium Amounts

With an on-exchange metal insurance plan, the average premium is based on the age of the individual, the family size and the income level. The premium will start at the lowest amount with a bronze plan and move up through the metal levels to the most expensive, which is platinum. As the premium amount increases, the plan benefits will increase and out of pocket costs will decrease.

BEFORE PREMIUM SUBSIDY IS APPLIED, the average rates found in the on-exchange health insurance marketplace are:

  • Bronze: $233 – $556
  • Silver: $258 – $617
  • Gold: $327 – $718
  • Platinum: $350 – $788

Once again your monthly premium will probably be much less depending on your particulars!

On-exchange marketplace plans are the only health insurance plans with premium subsidies for those who qualify. If you don’t qualify for a subsidy, it’s not necessary to use the on-exchange health insurance marketplace. Instead, you can speak with a Thomas & Associates Agent at No Cost and find out which option is best for your specific situation.

Cost-Share Reductions for On-Exchange Plans

With an on-exchange plan, cost share reductions are available for those with an income under 250% Federal Poverty Level (FPL). These reductions vary depending on the metal plan with Bronze plans requiring the largest out-of-pocket obligation and Platinum plans requiring the lowest out-of-pocket obligation.

If you’re not sure if cost-share reduction will benefit you, speak to a Jacksonville agent today and find out if an on-exchange plan is the best option for you.

Types of On-Exchange Plans

The design of on-exchange health insurance plans may be very different compared to plans found in the off-exchange health insurance marketplace. The same plan may be offered in both forms and will have the same price, if this is the case. However, on-exchange plans are designed as either PPO, HMO, POS, or EPO. This will limit your options and it’s important to understand each of these types of plans.

  • PPO or Preferred Provider Organization – This type of plan will allow you to pay less when you choose a doctor, hospital or providers within the plan’s network. However, you can choose an outside provider without a referral.
  • HMO or Health Maintenance Organization – This type of plan is limited when it comes to your choices. You will most likely need to choose a doctor or provider within the HMO and most of these plans will not cover an out-of-network provider, except in emergencies.
  • POS or Point of Service – This plan will allow you to pay less when you choose providers in the network. You can use out-of-network providers with a referral from a primary care doctor.
  • EPO or Exclusive Provider Organization – This is a managed care plan with services only covered when you use the hospitals, doctors and specialists within the plan’s network.

Along with limitations put on the type of plan you can choose, on-exchange health insurance plans may only be purchased during the enrollment period. Once the enrollment period has expired you won’t be able to use this type of a plan unless you meet the requirements of a special enrollment period.

Is an On-Exchange Plan Right for You?

Unless you qualify for a premium subsidy, using an on-exchange health coverage plan isn’t necessary. You will be able to choose from a larger variety of plans with a local agent helping you find the right health coverage, on-exchange or off-exchange.

If you need health coverage and you don’t want to deal with the confusing government marketplace or wait for the next enrollment period, call a Thomas & Associates Agent Today!

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