Guide to Health Benefits, Costs, and Key Dates

The Affordable Care Act (ACA) is a valuable option to gain access to affordable health insurance for nearly anyone who can’t get health insurance elsewhere, such as th rough an employer or Medicare.

Americans should be aware of their options to get health insurance through the Affordable Care Act and resources to help if they’re unsure how to get ACA insurance independently. Lets take a closer look at Affordable Care Act options available to you.

Affordable Care Act (ACA)

The Affordable Care Act, is a landmark healthcare reform bill passed in 2010. The law includes many critical provisions, including bans on denying coverage for people with preexisting conditions, marketplaces where nearly anyone without coverage elsewhere can shop for health insurance, and tax subsidies to make health insurance more affordable.

Affordable Care Act Plans come in the following form,

EPO (Exclusive Provider Organization): You can choose any health provider in the insurer’s network with an EPO
HMO (Health Maintenance Organization): With an HMO, your doctors and other healthcare providers work in coordination with the insurer. You have fewer options for choosing a provider, and must use an in network provider for the services to be covered.

Health coverage is divided into four tiers: Bronze, Extended Bronze, Silver, and Gold. With Gold you’ll pay more for coverage each month and less when you visit the doctor or receive other medical care. With Bronze, you’ll pay the least each month, but medical coverage is more expensive.

Assessing your typical healthcare spending when deciding on a plan and tier is important. A lower-cost Bronze plan may be tempting, but if you go to the doctor regularly or take multiple prescription medications, you may save more with a higher-tier plan. For example, you may find a Silver plan is best for balancing your costs especially if you qualify for a CSR cost share reduction.

When shopping for ACA coverage, you’ll find insurance providers such as:

Aetna –Ambetter - Blue Cross Blue Shield – Cigna - Community Health Choice – Molina – Oscar – United Health Care

Key Dates to Remember

If you want to sign up for a ACA plan or change your plan, you’re limited to doing so during the Open Enrollment Period (OEP) or a Special Enrollment Period (SEP), which you may qualify for depending on your personal circumstances.

ACA Open Enrollment Period (OEP)

Health Coverage Year

2025

Open Enrollment Dates

Nov. 1, 2024, to Jan. 15, 2025

As you can see, Open Enrollment Periods typically start at the beginning of November and close in mid-January for the next calendar year.

During an open enrollment period, you can sign up for new coverage or choose a different plan for the next year. Outside of open enrollment, you’re typically locked-in with the plan you picked during your last enrollment period unless you qualify for a Special Enrollment Period.

Special Enrollment Period (SEP)

A special enrollment period is available to individuals and households who meet specific criteria. You can typically get new coverage or change your coverage for 60 days following any of the following events:

Losing existing health coverage, including job-based, individual, and student plans, or losing eligibility for Medicare, Medicaid, or CHIP
Getting married or divorced, having a baby or adopting a child, death in the family that changes eligibility
Moving to a different ZIP code or county, student moves related to school, seasonal workers moving for work.
(must have had creditable coverage prior to move)
Being released from prison, jail, or detention
Changes in income affecting coverage eligibility for premium tax credits or cost-sharing reductions
Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act Corporation shareholder
Becoming a U.S. citizen, U.S. national, or lawfully present individual
Starting or ending service in AmeriCorps State and National, VISTA, or NCCC programs
Changes in your income or household status that affect your eligibility for premium tax credits or cost-sharing reductions

Short-Term Health Insurance

Short-term health insurance serves as a temporary solution, offering affordability and flexibility in situations where traditional plans may not be available. Our services bring you short-term health insurance plans at affordable and low premiums, making them an accessible option for many. They provide clarity with co-pays, deductibles, and maximum out-of-pocket expense limits, ensuring transparency in healthcare costs. With the ability to cancel coverage without penalties and various plan designs tailored to your needs, short-term insurance can offer immediate access to care without needing to satisfy deductibles first but vary by plan design.

When ACA coverage isn't an option, short-term insurance provides a vital safety net. For individuals facing gaps in ACA eligibility or waiting periods, short-term plans offer immediate protection against unforeseen medical expenses. Whether you're transitioning jobs, aging out of parental coverage, or experiencing other life changes, short-term insurance fills the void, ensuring you have access to essential healthcare services when you need them most. At Texans Benefit we're here to bridge the gap and provide temporary coverage solutions that prioritize your health and well-being.

Hospital Indemnity Health Insurance

Hospital indemnity insurance is a type of supplemental insurance that pays a specific amount per medical occurrence and can help you avoid massive medical debt. With the rise of medical deductibles and high out of pocket costs that exist with many commercial plans and high deductible plans this coverage can help bridge the gaps in your health care.

The American Hospital Association says over 33 million people in the U.S. are admitted to a hospital every year, many of whom may not be prepared for the cost. Even with proper health insurance, out-of-pocket costs can lead to financial strain—the average cost of a three-day hospital stay is $30,000.The American Bankruptcy Institute says medical debt is one of the leading reasons for bankruptcies. The U.S. Census Bureau estimates that 19% of American households carry medical debt with the median medical debt $2,000. Hospital indemnity insurance can provide a financial safety net if you’re hospitalized and left with significant medical bills to pay.