Health Insurance

What the ACA Has Done For You

Non-Discrimination: Everyone has access to essential health services without discrimination. Insurers cannot refuse coverage based on gender or pre-existing conditions.

No Coverage Limits: You can receive necessary medical care without worrying about hitting a coverage cap.

Extended Coverage for Young Adults: If you’re a young adult, you can stay on your family’s insurance plan until age 26, providing peace of mind during the transition from college to early career stages.

Comprehensive Coverage: These plans cover a wide range of services, including doctor visits, outpatient care, prescription drugs, emergency care, mental health services, and preventative medical care.

Remember, the ACA Health Insurance Marketplace is a valuable resource for finding affordable and comprehensive health coverage. Whether you’re seeking medical care, dental services, or vision coverage, exploring the Marketplace options can help you make informed decisions about your health insurance needs.

Choosing the Right Health Plan

At J.A. Johnson Health Insurance we use the following criteria when selecting a plan based on your needs.

Budget: Assess your current financial situation and future financial responsibilities or goals. Consider the monthly premium charged and whether there’s an annual deductible—the amount you must pay for medical costs before coverage begins.
Medical Needs: If you have a chronic condition or health concern that requires medical specialists or prescription medications, make sure the plan covers these needs.
Plan Type: Decide which type of health insurance plan—HMO, PPO, EPO, or POS—is best for you and your family, and whether you want an HSA-eligible plan.
Coverage Level: Health plan categories such as Bronze, Silver, Gold, and Platinum offer varying levels of coverage and out-of-pocket costs. Choose a category that aligns with your healthcare usage.
Provider Network: If you prefer a specific hospital, primary doctor, or specialist, ensure they are included in the plan’s network.
Prescription Drugs: Check if the plan covers the medications you need and what the costs would be.
Additional Benefits: Some plans offer extras or perks such as wellness programs, gym memberships, or telehealth services.
Quality of Care: Research the quality ratings of the plan’s providers and hospitals.
Plan Restrictions: Understand any restrictions on services, referrals, or the need for pre-authorization for certain procedures.
Total Costs: Look beyond the premium to understand the total costs for healthcare, including co-pays, coinsurance, and out-of-pocket maximums.

To ensure you choose the best plan for your needs, we thoroughly assess each criterion, enabling you to make a well-informed decision that aligns with your personal requirements.

Types of Plans

There are 5 different types of plans: Bronze, Silver, Gold, Platinum, and Catastrophic.

When finding the right plan for you remember budgets (premium amounts, copays, tax credits, and cost sharing options and of course networks of your doctors. This plans work best for those who very serious health concerns.

Rates and premiums are also based on age. Someone who is 25 will pay less than someone who is 50. However, there are also tax subsidies that help people pay for their premiums as well.

Catastrophic

Catastrophic policies pay less than 60% of the total average cost of care.

Catastrophic plans must also cover the first three primary care visits and preventive care for free, even if you have not yet met your deductible.

Bronze

Bronze covers 60% on average of your medical costs; you pay 40%.

Bronze plans have lower premiums, higher deductibles, and higher out of pocket maximums. These plans are generally for healthier people that may go to the doctor once or twice a year and do not take medications on a regular basis.

Some Bronze plans and Silver plans also have what HSA plans these plans do not have copay and you pay everything up front until you reach the deductible. You can pay for services through an HSA account. A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit.

Silver

Silver covers 70% on average of your medical costs; you pay 30%.

Silver plans have medium premiums, medium deductibles, and about the medium out of pocket maximums. Silver plans also have what is called Cost Sharing Reduction (CSR). A discount that lowers the amount you have to pay for deductibles, co-payments, and coinsurance. In the Health Insurance Marketplace, cost-sharing reductions are often called “extra savings.” This is also based on income. This plan works best for people that either qualify for the CSR and/or have some health conditions that require regular checkups, testing, and medications.

Gold

Gold covers 80% on average of your medical costs; you pay 20%.

Gold plans are fourth plan and these are these plans have high premiums, low deductibles and lower out of pocket maximums. These plans are for people with serious health concerns. Have regular doctor appointments and being treated for serious illnesses.

Platinum

Platinum covers 90% on average of your medical costs; you pay 10%.

Platinum plans are the highest premium plans and have the lowest deductibles and out of pocket expenses. This plans work best for those who very serious health concerns.

How do Tax Credits Work

The Affordable Care Act (ACA), also known as Obamacare, works with tax credits to help make health insurance more affordable for individuals and families. Here’s how it works:

Premium Tax Credits: These are subsidies provided by the ACA to help lower the cost of health insurance premiums for those who qualify. The credits are available to individuals and families with incomes between 100% and 400% of the Federal Poverty Level (FPL).
Advance Premium Tax Credits (APTC): Eligible individuals can choose to have these tax credits paid in advance directly to their health insurer throughout the year, which reduces their monthly premium payments.
Eligibility: To qualify for these tax credits, you must purchase health insurance through the Health Insurance Marketplace, also known as the Exchange. The size of the premium tax credit is based on a sliding scale – those who earn less pay less.
Reconciliation: If you choose to take the APTC, you must reconcile the amount on your tax return. If your actual income is higher than estimated, you may have to pay back some or all of the APTC.
Affordable and Adequate Coverage: If your employer offers health insurance that is considered “affordable and adequate,” you are not eligible for the ACA marketplace coverage and the tax credit. “Affordable” is defined as a premium that does not exceed 9.5% of your yearly income.
Temporary Expansion: For tax years 2021 and 2022, the American Rescue Plan Act temporarily expanded eligibility for the premium tax credit by eliminating the upper income limit of 400% FPL.

These tax credits are designed to make health insurance more accessible and affordable, especially for those with lower to moderate incomes. It’s important to accurately estimate your income to get the correct credit amount and avoid owing money when you file your taxes.

Contact Us

Opening Hours:
Mon – Fri — 9:00 am – 5:00 pm
Saturday — Closed
Sunday — Closed

We do not cover every Medicare plan available in your area. Currently, I represent 8 organizations which offers 57 products in your area. Please contact Medicare.gov. or 1-800-Medicare or your local State Health Insurance Program (SHIP) to get all of your options.