health insurance

One of the most vital things to protect in life is your family’s health. Therefore, having health insurance is the place to start. It will provide financial protection if you or your loved ones fall ill or are in an accident.

Health Insurance is truly for EVERYONE. No one is safe from an injury or illness, therefore having health insurance is critical. However, based on your current health you can choose between different plans that will fit your needs and budget.

Marketplace (Affordable Care Act) Health Insurance Easily Explained:

Health insurance will not always pay 100% of your expenses, in fact it is more like a cost sharing concept. Once you hit a certain point, which is called your out-of-pocket limit/maximum, your insurance will pay 100% of covered expenses.

You will need to be familiar with the following terminology to be able to make an informed decision on what Marketplace health insurance plan is right for you.

Here’s a breakdown:

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Premium

Is what you pay per month to keep your health insurance active.

Thanks to the Affordable Care Act, there are only five factors that go into setting your premium:

  1. Age
  2. Location 
  3. Tobacco or non-tobacco
  4. Individual vs Family Plan 
  5. Type of plan you select
Copay

Is the amount you pay for certain provider services or prescription medication.

Deductible

Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.

Out-of-Pocket Limit

Is the most you could pay in a year for covered services. If you have other family members on the plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.

Coinsurance

Unlike co-payment, this amount is not fixed, it is a percentage. You will have to pay this percentage on covered services until you reach your out-of-pocket maximum.

Prescription Drug Coverage

Tier 1 is known as the most affordable drugs (often covered at no-cost or by paying a very low co-pay), and Tier 4 drugs are the most expensive to cover.

Tier 1 – Generic Drugs
Tier 2 – Preferred Brand Drugs
Tier 3 – Non-Preferred Brand Drugs
Tier 4 – Specialty Drugs

Excluded Services

All plans include a list of services that are not covered under plan. Ensure to refer to your plan’s Summary of Benefits for full list.

Advantages of enrolling in a Marketplace plan

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Pre-existing conditions are covered, and you cannot be turned down for having one. This is huge!

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Your gender is not considered when setting your premium

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You may be eligible to qualify for a tax credit/ subsidy. A premium tax credit will help make your premium more affordable and possibly help you afford the right health insurance plan for you and your family.

When can I purchase health insurance through the MarkEtplace?

Open Enrollment in Texas for 2021 coverage runs from November 1st – December 15th, 2020. If you miss out, you will not be able to purchase a plan, unless you qualify for a Special Enrollment Period.

Some examples of life changes that can qualify you for a Special Enrollment

If your or anyone in your household in the past 60 days:

  • Got married.
  • Had a baby, adopted a child, or placed a child for foster care.
  • Got divorced or legally separated and lost health insurance.
  • Died.
  • Moving to a new zip code. (You must prove you had qualifying health coverage for one or more days during the 60 days before your move. You don’t need to provide proof if you’re moving from a foreign country or United States territory).
  • Loss of health coverage. (You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days).

IMPORTANT marketplace announcement- 2021

Need to get insured or change your plans? It’s now easier, for a limited time.

For Affordable Care Act (ACA) plans, typically anyone can enroll during “Open Enrollment” which runs Nov 1–Dec 15, and outside of those dates, people need a qualifying “life change” to enroll (such as having a baby, marriage, moving cities, etc).

Due to the exceptional circumstances of Covid-19, most states are now allowing anyone* to enroll without a qualifying life change from Feb 15th through May 15th also – they’re calling this a “Covid Special Enrollment Period.” 

If you are a TX Resident we invite you to reach out to us so we can help you enroll in the right plan based on what matters to you most. 

*Please refer to your specific state for exact details

ready to see Marketplace plans and prices?

Health Insurance

You can visit our site by clicking below link!

You can even self-enroll if you’re eligible (available to Texas residents only).

ready to see Marketplace plans and prices?

You can visit our site by clicking below link!

You can even self-enroll if you’re eligible (available to Texas residents only).

If Marketplace coverage is not for you, or if you missed open Enrollment and don’t have a qualifying event to purchase coverage, you may want to consider a Short Term Medical Plan.

Why short term insurance?

Short Term Medical plans are designed to give you access to health coverage for a limited time when, for whatever reason, employer or Affordable Care Act Insurance isn’t available to you.

You just graduated or retired early. You’re between jobs. You missed open enrollment or waiting for other coverage to start.

  • Apply for coverage any day of the year – No qualifying event needed. No waiting for an enrollment period.
  • Complete a short medical application – Short Term Medical is medically underwritten. Application questions help determine if you’re eligible for coverage.
  • Choose your plan duration from 1 month to just under 12 months (depending on the state where you reside).
  • Pick your plan. Different plans to choose from with several deductible options.
  • Coverage may be in force as soon as the following day of applying.
Not having health insurance coverage for even a short amount of time can be expensive. What if you have an accident? What if you fall ill?

Highlights:

  • Coverage for doctor visits, urgent care visits, emergency room, hospitalization, outpatient spine and back visits, limited preventative care and more.
  • Prescription coverage available with some plans.
  • Broad network access to quality care.

We’re a proud member of the Marketplace Circle of Champions for 2021

We’re a proud member of the Marketplace Circle of Champions for 2021

If you would like to learn more about health insurance in the state of Texas, We would be happy to help you through the stress of figuring out which plan is right for you and if you qualify for a subsidy to help make your premiums more affordable.

Please call us today toll-free at: 833-4-AVANTI (282684) or click HERE to get started now.

We look forward to hearing from you and showing you why we are the right agency to place your trust with.

-The Avanti Team

Get in Touch

13785 Research Blvd.
Suite 125
Austin, TX 78750

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