Health Insurance

Searching for health insurance can feel overwhelming. Understanding the numerous options, terms, and networks can be challenging. You need guidance from an expert familiar with the industry who can assist you in navigating through the complexities to identify the best plan for your requirements and financial situation, including health insurance Marketplace plans. Allow us to collaborate with you to assess your needs thoroughly. This will enable us to tailor a benefits package that meets both your healthcare needs while keeping to a budget you are comfortable with.

Individual and Family Health Insurance Options

Marketplace Health Insurance
Off Marketplace Health Insurance
Short Term Health Insurance

Marketplace Health Insurance (ACA Plans)

Affordable Care Act or Obamacare plans

Affordable Care Act/Obamacare plans

The Affordable Care Act or ACA is a healthcare reform law that was enacted back in 2010 to help more American’s have access to affordable, quality health insurance coverage. The law also assists individuals who fall between 100% to 400% of the federal poverty limit (FPL) with subsidies to help pay for the insurance premiums. For the 2023 plan year, 90% of enrollees in the Marketplace qualified for subsidies (APTC); 48% qualified for cost sharing reductions(CSR).

What Does Marketplace Health Insurance Cover?

Insurance plans offered through the Health Insurance Marketplace typically cover a range of essential health benefits, as mandated by the Affordable Care Act (ACA). All marketplace plans must cover treatment for pre-existing medical conditions. No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started.

Preventive Care: This includes screenings, vaccinations, and counseling for conditions such as obesity, depression, and smoking cessation.
Emergency Services: Coverage for emergency room visits, including ambulance services.
Hospitalization: Treatment for illnesses and injuries requiring hospital stays, including surgeries and overnight stays.
Prescription Drugs: Many plans offer coverage for prescription medications, with varying copayments or coinsurance depending on the specific drugs and plan.
Maternity and Newborn Care: Prenatal care, childbirth, and care for newborns.
Mental Health and Substance Use Disorder Services: Coverage includes counseling, therapy, and treatment for mental health conditions and substance use disorders.
Pediatric Care: This includes well-child visits, immunizations, and dental and vision care for children.
Lab Tests and Diagnostic Services: Coverage for laboratory tests, such as blood tests and X-rays, as well as diagnostic services like MRIs and CT scans.
Rehabilitative and Habilitative Services: Coverage for services aimed at helping individuals recover from injuries or manage chronic conditions, as well as services to help individuals with disabilities learn new skills or adapt to daily life.
Ambulatory Care: Outpatient services, including doctor visits, specialist consultations, and outpatient surgeries.

Plans will vary based on your location. The carriers that we represent are; Blue Cross Blue Shield, United Healthcare, Aetna, Oscar, Baylor Scott & White, Cigna, Ambetter, Molina, Christus, and Ascension. Since not all plans are offered everywhere, it is best to work with a licensed independent insurance agent to help you find the plans that are offered in your area.

Who Can Qualify for ACA Marketplace Health Insurance?

There are many different factors that makes individuals eligible for subsidized Obamacare health insurance. Here is a list to name a few:

For individuals, if you are between the ages of 26-64, and you do not have access to affordable group health insurance through your employer, you may be eligible for ACA coverage.
You are a US citizen or you are lawfully present in the United States for the duration of the plan year.
Your income falls between 100% – 400% of the Federal Poverty Level based on your tax household and filing status. If you are married, you must file jointly.
You are self-employed and your MAGI falls between the 100% – 400% of the Federal Poverty Level.
If you are retired and do not have access for a job based health insurance plan

When Can I enroll in an ACA Marketplace Plan?

Open enrollment period for ACA Marketplace plans occurs once a year. You can enroll directly through our enrollment link. If you missed open enrollment, there are also special enrollment periods (SEPs) during which you can sign up for coverage outside of the regular open enrollment period. Here’s an overview of both:

Open Enrollment Period: The open enrollment period runs from November 1st-January 15th. During this time, you can enroll in a new health insurance plan, switch plans, or make changes to your existing coverage.
Special Enrollment Period (SEP): SEPs allow individuals and families to enroll in or change Marketplace coverage outside of the regular open enrollment period, provided they have experienced certain qualifying life events. Qualifying life events may include:
- Marriage or divorce
- Birth, adoption of a child, or placement for foster care
- Loss of minimum essential coverage (MEC). This includes loss of job-based coverage, Medicaid, CHIP, COBRA in the last 60 days
- Change in household size (e.g., gaining or losing a dependent)
- Relocation to a new area that offers different Marketplace plans
- Loss of eligibility for Medicare, Medicaid, or CHIP during the redetermination period
- Certain changes in income that affect eligibility for premium tax credits or cost-sharing reductions
- If your income falls between the 100% -150% of the FPL. (This is a temporary SEP and is subject to change.)
- Released from incarceration
- Gained a lawfully present immigration status or became a U.S. citizen.

If you experience a qualifying life event, you have a limited time window (usually around 60 days) to enroll in a new plan or make changes to your existing coverage through a special enrollment period (SEP). It’s essential to act promptly and provide documentation of the qualifying event when applying for coverage during an SEP. Call us to discuss if you are unsure whether or not you may qualify for a special enrollment election period. This is constantly changing, so it doesn’t hurt to check and see.

Why Choose Us?

At First Integrity Insurance Solutions, we put our clients firmly at the forefront of our competitive Insurance Agency. We specialize in providing excellent customer service and help our clients find coverage that works for their unique needs. We have extensive expertise in working with insurance carriers and can answer any questions you may have and provide advice for the best insurance plan for your healthcare needs and budget. As an independent health insurance broker, we impartially help you compare plans that fit your specific needs and only partner with top-rated, reputable individual health insurance providers, including Blue Cross Blue Shield, United Healthcare, Aetna, Cigna, and more.

Enrollment

It is always beneficial to have an expert review your situation and provide guidance on the best options available to you. You call us or fill out the form on your right, to have one of our health insurance specialists contact you to help find the best coverage for your needs at affordable prices. You can also enroll directly through our enrollment link if you want to go that route. Ask us about dental and vision insurance as well!