Let’s go over how coverage works.
How comfortable are you navigating Affordable Care Act (ACA) insurance ... or insurance at all? No matter where you’re at, we’ve covered what you need to know for open enrollment on November 1.
Dig deeper into the ACA
All ACA plans must cover 10 essential benefits like hospitalization, preventive care and mental health services. Some plans offer extras like dental and vision.
Every plan is assigned what is known as a metal tier: Platinum*, Gold, Silver or Bronze. Metal tiers have nothing to with the quality of care you receive. They determine how you and your plan split costs.
You can apply for ACA coverage and financial help through companies with direct enrollment sites, like us, or on the federal marketplace. If you shop off the marketplace, you won’t get financial help.
When you enroll in an on the marketplace plan, you may be eligible for discounts on your monthly bill or extra savings on your out-of-pocket medical costs.
The top insurance terms you'll want to know
Let's go over some common insurance terms you might see during your coverage search.
Health care answers in 60 seconds.
What are health care premiums, deductibles, coinsurance, and copays?
To better understand these terms, think of it like owning a car.
A premium is like your monthly car payment.
You must make regular payments to keep your car, just as you must pay your premium to keep your health care plan active.
A deductible is the amount you pay for coverage services before your health plan kicks in.
After you meet your deductible, you pay a percentage of health care expenses known as coinsurance.
It's like when friends in a carpool cover a portion of the gas, and you, the driver, also pay a portion.
A copay is like paying for repairs when something goes wrong.
When your car gets serviced, you pay a set fee to the mechanic, just as you may pay a set fee, like $20, when you go to the doctor because you're sick.
Every plan is different, so premiums, deductibles, coinsurance, and copays can vary in cost.
Health care question answered.
Is ACA coverage right for you?
If you don’t have insurance through your job or a government program like Medicare, take a look at ACA plans. They’re available for almost everyone. And they can help you take care of your most important asset — you.
I work at a part-time job that doesn’t offer insurance.
You don’t need to work full time to get ACA coverage. Your income may even qualify you for a premium discount and extra savings.
I lost my job and my health insurance coverage.
You’ve got options. One of them may be COBRA, but this coverage typically runs out after 18 months, and it can be pricey. The good news is that ACA coverage typically costs less.
I run my own business, but I don’t have employees.
With ACA coverage, you can choose the premium and out-of-pocket costs that are right for you. You may even be able to deduct the premiums you paid on your income tax.
I’m a freelancer, gig worker or consultant.
With lots of ACA plan choices available, you get to choose what best fits you. And since you’re self-employed, you may even get a tax break on your premiums.
I work at a part-time job that offers insurance.
You can still buy an ACA plan. But if your employer’s plan meets certain affordability and quality standards, you may pay less for employer coverage than an ACA plan.
I’m retired, but not old enough for Medicare.
With ACA coverage, you’ll find many plan options and you may even qualify for financial help to lower your costs. Plus, everyone who applies can’t be denied coverage for preexisting conditions.
Save the date:
ACA enrollment periods
When is the Open Enrollment Period?
The period opens November 1 and closes January 15. This is the time of year when you can explore plan options, see if your doctor participates in the plan, apply for financial help and purchase health plan coverage. So you don’t want to miss out.
If I miss the deadline, can I still sign up?
Life won’t wait for open enrollment. So certain life events — called qualifying events — let you sign up for coverage outside the typical open enrollment window.
What’s an example of a qualifying life event?
Health care answers in 60 seconds.
When can you change your health insurance?
Typically, you sign up for a new health plan during open enrollment.
But you may also change your plan under special circumstances called qualifying life events.
Here are common events...
Loss of insurance.
If you lose coverage because you’ve aged out of your parents’ plan, lost your job, or switched your job, you qualify.
Change in household.
If you get married, have a baby, or when the number of people in your family changes, you qualify.
Health care question answered.
What’s an example of a qualifying life event?
Maybe you no longer have health care coverage because you’ve lost your job. Or maybe you’re getting married or having a baby or moving to a new state. These life events — and others — all give you the right to sign up for a health plan outside the Open Enrollment Period as long as you do so no more than 60 days after the event.
*We don’t offer Platinum plans … yet. You can check out the great features of our Gold, Silver and Bronze plans on AetnaCVSHealth.com on November 1.
Legal notices
Health plans are offered or underwritten or administered by Coventry Health Plan of Florida, Inc., Aetna Health Inc. (Georgia), Aetna Life Insurance Company, Aetna Health of Utah Inc., Aetna Health Inc. (Pennsylvania), or Aetna Health Inc. (Texas) (Aetna). Aetna is part of the CVS Health family of companies.
Health benefits and health insurance plans contain exclusions and limitations.