Frequently Asked Questions

What is Obamacare?Obamacare is the colloquial term for the Affordable Care Act (ACA). The ACA revamped the health care financing system for the United States. The mechanism to achieve univerasal coverage is comprised of employer mandates, individual mandates, subsidies and government insurance programs. Individuals and employers who do not meet their obligations under the act are subject to fines and penalites.
How can I get health coverage now that Open Enrollment is over?After open enrollment ends, you can only purchase ACA compliant coverage if you expeience a qualifying event such as loss of coverage through employment termination, divorce or children exceeding the age limit of a group plan.Short term coverge may be available, but short term plans do not qualify as ACA coverage and penalties are still applicable.
Are Short Term health policies ACA compliant?No. Even if you are covered during the entire year under short term coverage you are subject to the penalty for not having coverage.
How can I find out if my doctor is in the plan's network?Each carrier provides an electronic provider directory, usually on the home page. Be careful. Your physician may be contracted with a carrier but in networks where you have no access. Make sure the physician is in the newtork for your specific plan. In addition, some physicians that accept your network may only accept patients enrolled in certain metal tiers.
How can I find out if a plan covers my prescription drugs?Each carrier provides an electronic formulary where you can find the drugs that are covered. It is usually on the home page.
What is the difference between Bronze, Silver, Gold and Platinum plans?Bronze plans must pay at least 60% of all incurred claims. Silver must pay 70%, Gold must pay 80% and Platinum must pay 90% of incurred claims. Consequently, Bronze plans offer lower premiums and benefits. As you move up in metal tiers, the rates are higher and so are benefits.