If you do not receive health insurance through your employer, then your first thought may be an Obamacare health plan. These types of plans refer to alternative health care plans not listed through the government-operated healthcare marketplace. Though you can receive this type of non-ACA health care, there are some key points you need to know.
Essential Health Benefits
One of the key points to know regarding non-ACA health care plans deals with essential health benefits. Essential health benefits are those benefits that the government declares must be part of accepted health insurance plans. These benefits include emergency care, maternity, hospitalization, prescriptions, and other key health care options. Non-Obamacare plans and Obamacare, or nonmarketplace and marketplace plans, can have more benefits per plan. However, they must contain those essential benefits.
Design of the Plan
Some plans are offered on both the marketplace and nonmarketplace platforms. The difference is in the design of the plan. This plan design can be in name only, or it can be in slight percentage differences for different procedures and benefits. For example, you may find a silver plan offered by a major insurance company in the marketplace. This Obamacare plan may be listed as a silver plan with a $35 copay for basic visits. The difference between this plan and the same company's nonmarket plan may be in the name. The name may be listed as the preferred silver or preferred plan instead while the copay is $35 after a certain number of visits or before deductibles are reached. All other benefits may be exactly the same.
Participants in Network
The key point for many people is which doctors are in the network. You may find that the plan you want as a non-ACA plan has fewer healthcare providers than the Obamacare or ACA available plans. This means you will have to ensure that your doctor or the doctors you want to see are listed as participants in the network. Keep in mind, if the network is smaller, the referral options may also be smaller for specialists you may need later.
If you believe you want a non-ACA health care plan, contact a health insurance provider. They can help narrow down your off-marketplace or non-Obamacare options. They can also help you compare and contrast your options to determine the best option for your situation. If you have specific health needs you will need to discuss those at the time you begin looking for your insurance plan. By informing the insurance representative of these health issues, they can help rule out plans that may not be suitable.