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Millions of Americans have plans through the Affordable Care Act Marketplace right now. The pandemic drove many to unemployment, and the government infused the ACA with more funding and support to assist those individuals and families affected most. You might be finding yourself with a new-to-you ACA plan, too.

The ACA has so many different plans and federally mandated services, and it can be challenging to sort through every benefit. As a result, you could be enrolled in a great plan and still not be taking full advantage of all the services at your disposal. Today, we’ll carve out three things you can do to ensure you’re squeezing every last benefit from your ACA plan.

Leverage the Essential Benefits

You might be used to a traditional, employer-sponsored group plan with strict policies and limited freebies. Now that you’re enrolled with an ACA plan, you might assume that routine healthcare services might come at a cost. To make sure you’re getting the most out of your coverage, it’s important to explore the required Essential Health Benefits. The best part is some of these care efforts won’t cost you a dime.

What Are Essential Benefits?

Per the ACA plan guidelines, there is a set of ten categories of healthcare services that all health insurance plans must cover. Some plans will offer additional coverages, but these ten particular care services are required. Your ACA plan has to include doctor visits, hospital care, mental health services, prescription drugs, and more. Dental coverage for children is also required. And it’s essential to check with your state, as well, since requirements may differ, adding to these ten essential benefits.

Preventive Health Efforts

Your ACA plan is also required to cover preventive healthcare services at no cost to you. These include routine physicals, lab work, and screenings. The preventive care rules break down into three categories: adults, women, and children. And these coverages extend to immunizations, tobacco use screenings, and cancer prevention measures.

Why These Are Important

People sometimes put off important doctor visits because of perceived affordability. It’s essential to know what services are accessible to you under your ACA plan so that you can take advantage of every healthcare measure. It’s not uncommon for an individual to have an accident and refuse to go to the ER because of costs. Knowing your plan’s coverage for ER services and hospital stays means knowing it’s ok to seek care and treatment in those situations. And preventive care is crucial for staving off long-term health conditions.

Knowing & Using the Right Resources

It’s hard to get into the insurance jargon to sort what coverages and plans offer. This is why it’s also important to know what tools and resources you have at your disposal to help. To really make the most of your ACA plan, leverage every tool in the toolbox to find the most appropriate plan for you.

Tools & Resources

It goes without saying, W3LL can be the most significant ACA Marketplace enrollment tool you have. You can browse available plans, compare coverages and costs, and enroll directly through W3LL. And every detail is available, in a language you can understand, to help you make the most educated decision about your health insurance. We can also help you calculate and apply for premium tax credits, so you can know precisely what your premiums, co-pays, coinsurance, and out-of-pocket costs will be.

Shopping Around Matters

Don’t rush into the first plan that sounds like a good fit. You might be overwhelmed and agree to enroll with an ACA plan that looks a lot like the traditional group plan you had before. Instead, shop around and compare everything, not just costs. Compare plan coverage options across all metal tiers.

Look at in-network providers for each plan to make sure your chosen doctors are included. With thousands of different plan options, you will want to shop around to find the best-fit enrollment plan.

Asking Questions

Don’t underestimate the power of asking questions. Even if you’re already enrolled in an ACA plan now, don’t hesitate to reach out to your provider and inquire about what preventive care services they cover. If you don’t know about in-network providers or have questions about coinsurance costs, call and ask or hop online to chat digitally.

Stay on Top of Qualifying Life Events

One of the benefits of leveraging an ACA plan is knowing that when your life changes, your health insurance can change, too. Stay on top of your Qualifying Life Events so you can improve your coverage with every opportunity. Unlike traditional group plans, the ACA plan is designed to change with you.

What Are Qualifying Life Events

A Qualifying Life Event (QLE) is a life change that makes you eligible to re-evaluate your ACA plan via a Special Enrollment Period. There are four primary types, including a loss of health coverage, a change in your household, a new residence, and other events like citizenship or incarceration. If you get married, are expecting a baby, or age out of your parents’ health insurance, you can shop for a new ACA plan. These life dynamics will change your income level, family size, and healthcare needs. Staying on top of your plan along the way will mean you’re always getting the most of your ACA plan.

Being Honest About Your Health Needs

It’s really important that you be honest with yourself about healthcare needs. Even if you’re relatively healthy, you should be mindful of potential health risks down the road. Pre-existing conditions are always covered under an ACA plan. So don’t be hesitant to inform yourself about your health. Schedule the screenings and routine exams. Know your cholesterol levels and blood pressure. The more honest you are with yourself about your needs, the more informed you can be when it comes time to choose or change your ACA plan.

Taking Quick Action

When you experience a QLE, you’ll need to take action soon. There are strict timelines in place that limit how much time you have to browse and enroll in a new plan. Special Enrollment Periods usually extend up to 60 days following the event. And when you apply, you might also be required to prove your eligibility based on the QLE you experience.

To make the most out of your ACA plan, take advantage of these key tips. And always rely on W3LL to help you navigate the Marketplace. Whether it’s your first time browsing or you’re ready for a plan upgrade, we can take the guesswork out of the shopping and enrollment process.


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