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It’s pretty hard to believe the year is almost over already. And around the corner are the holidays, the winter season, and, yes, Open Enrollment. It will soon be that much-anticipated and special time of year when you’ll have to sit down and evaluate your healthcare and financial situations again. If you’re interested in a step-by-step guide to choosing a Qualified Health Plan, you’re in luck. Today, we’ll help you with everything you need to know and hopefully take the guesswork out of selecting the right health coverage for you and your family in 2022. Preparing now can translate to a seamless and effortless enrollment during this Open Enrollment period.

What Is a Qualified Health Plan, Anyway?

There is more to understanding a Qualified Health Plan than you might think. Not all health insurance products are alike, nor do they cover equally. So, it’s best to understand what makes the Qualified Health Plan more advantageous or different from other plans.

Official Definitions

A health insurance plan is just another health insurance plan, unless it’s part of the Affordable Care Act, certified by the Health Insurance Marketplace or the Federally Facilitated Marketplace (FFM.) A Qualified Health Plan will also cover a complete roster of essential benefits, including preventive care coverages. In addition, these plans, also ideal for the budget-conscious consumer, follow set limits regarding maximum out-of-pocket expenses, deductibles, and copays.

Coverage Examples

Some of the example coverages you can expect with a Qualified Health Plan include the aforementioned preventive care services, including annual physicals and screenings. Emergency room visits and hospitalizations are also covered. Additionally, Qualified Health Plans have provisions for mental health services as well as substance abuse treatment programs.

Metal Tiers & Categories of Coverage

To sort the various Qualified Health Plans on the ACA Marketplace, it may be helpful to rely on the metal tiers. Bronze, Silver, Gold, and Platinum level plans can help you determine which is an ideal fit for your budget and healthcare needs. These categories of coverage outline actuarial coverage, whereas a bronze plan must include 60 percent of the expected costs, a silver plan covers 70 percent, the gold plans cover 80 percent, and platinum level plans cover 90 percent of expenses for the average individual under the plan.

Exploring Your Qualified Health Care Options

Now that you know what Qualified Health Plans are and how they work, you can begin your search to enroll in one. Of course, you’ll want to be ready for the upcoming Open Enrollment period. And you’ll also want to have a good understanding of your household budgets and predicted healthcare needs for the upcoming year.

Open Enrollment

You may have health insurance now, but Open Enrollment is coming. It’s that time of year when eligible Americans explore their Qualified Health Plan options and enroll in coverage for the following year. Getting ready now means having all your information on-hand for the November 1 through December 15 window to enroll.

Special Enrollment Periods

If Open Enrollment comes and goes and you find yourself needing coverage later, you might still be able to enroll in a much-needed Qualified Health Plan by way of a special enrollment period. Should you lose your job or employer-sponsored plan, for example, you would become eligible to enroll within a designated time frame following your loss of coverage. You can also qualify with a move, changing the number of people within your family, or changing your marital status.

Discovering Your Healthcare & Budget Needs

Even if you currently have an existing health insurance plan and don’t anticipate any new needs this Open Enrollment period, it’s probably still a good idea to sit down with your household finances and healthcare needs for the upcoming year. It’s important, in either situation, to know what you can afford and have an idea of anticipated healthcare needs. Then, in the event you face an unexpected loss of coverage, you’ll be better prepared to make a Qualified Health Plan selection.

What You Should Know Before Enrolling

Before enrolling in a Qualified Health Plan, there are a few additional details to know. In this guide to choosing the right coverage, these considerations are significant. And whether you enroll in the upcoming Open Enrollment period or via a special enrollment period later, they’re details that will affect your decision.

Premium Tax Credits

Browsing the available health insurance plan on the ACA Marketplace, you’ll notice some of those monthly premium costs seem high. And they can be, but it’s not the whole picture. You should first apply for premium tax credits or subsidies that can be automatically applied to those monthly premiums, offering significant cost reductions. Eligibility for these tax credits will depend on your household income levels and member configuration. But in some cases, individuals could find plans costing less than $100 each month. So don’t enroll without checking to see if you qualify.

Understanding Your Coverage

The various plan categories will help you determine the percentages of coverage and cost for each plan. But there are other coverage details you’ll need to look for, too. For example, some providers have restrictions for in-network and out-of-network healthcare costs. Others have language regarding coinsurance cost-sharing. These nuances, if not assessed prior to enrollment, could end up costing you in the long run.

Let W3LL Help

When you’re confident you have your income and healthcare needs outlined, let W3LL help you get started on your search for health insurance. Open Enrollment begins soon, and we can ensure you understand every step of the process so you can make the most educated Qualified Health Plan decision for you and your family.


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