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Changes to What You Buy

Want to know more about the health reform law and what it means for people without employer-based health insurance? We’ll walk you through the basics of how Affordable Care Act (ACA) has changed the health insurance buying process, all in three steps:

  1. Changes to WHAT you buy
  2. Changes to HOW you buy
  3. Changes to WHEN you buy

No More Pre-Existing Conditions

The ACA eliminated pre-existing conditions starting 2014. No more pre-existing conditions means you can’t be denied coverage, charged more, or denied treatment based on health status.

Preventive Care At No Out-Of-Pocket Cost

At least 15 free preventive services and one wellness visit are covered on major medical plans sold after 2014 without any out-of-pocket cost, regardless of whether you have met your deductible yet. Services must be done in-network to avoid cost sharing.

10 standard essential benefits

If the plan you have today or buy this year does not meet the new government standards of the “10 standard essential benefits”, you may have face tax penalties. Any major medical plan you purchase through Augeo Benefits will cover the minimum of 10 standard essential benefits, so you don’t face tax penalties. These standard essential benefits include:

  • Laboratory Services
  • Pediatric Services
  • Emergency Services
  • Rehabilitative Services & Devices
  • Mental Health Services and Addiction Treatment
  • Preventive Services, Wellness Services, and Chronic Disease Management
  • Prescription Drugs
  • Ambulatory Patient Services
  • Maternity & Newborn Care
  • Hospitalization

Levels of Coverage

In 2014 a new metallic rating system was introduced to make it easier to tell what level of coverage you’re buying. All metallic plans must cover at least 60% of total average estimated costs for the plan’s benefit package. Meaning, 60% of covered medical expenses paid by the insurance company; 40% by the consumer.

  • Platinum = 90% MOST COVERAGE
  • Gold = 80%
  • Silver = 70%
  • Bronze = 60%
  • Catastrophic < 60% LEAST COVERAGE

Catastrophic plans are only for people under the age of 30 and they may cover less than 60% of the total average estimated costs for the plan’s benefit package. 

Types of Health Insurance Plans You Can Buy

Plans that help you avoid the tax penalty

  • Major Medical Plans: Under the ACA, people who do not qualify for or want a subsidy, but who want to avoid the tax penalty, can buy major medical health plans that meet government coverage standards on or off of government-run state exchanges.
  • Qualified Health Plans (QHP): These plans meet the same coverage requirements as the Major Medical Plans, but QHPs can be purchased with an Obamacare subsidy, also known as a premium tax credit.
  • Catastrophic Plans: Catastrophic plans for people under age 30 will also be available. These plans cannot be purchased with a subsidy. Those who buy a catastrophic plan will not have to pay tax penalties for being uninsured but their plans provide the bare minimum benefits allowed under the law

Plans that fill gaps in coverage

  • Supplemental Plans
    • Life Insurance
    • Dental Insurance
    • Vision Insurance
    • Critical Illness Insurance
    • Accident Insurance
  • Gap (Short-Term) Plans: Outside of an enrollment period, people may have to wait to get coverage. Gap insurance products like short-term medical insurance may be helpful if you need limited coverage outside of the enrollment window.


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