Health Insurance

Health Insurance for Individuals and Families

Looking for a health plan through the Affordable Care Act Marketplace? We can help! MAC Insurance helps individuals and families find reliable, affordable coverage. Plus, the Inflation Reduction Act of 2022 has made many plans even more budget-friendly.

What Are ACA Plans?

The Affordable Care Act (ACA), also known as Obamacare, became law in 2010 during President Obama's time in office. It was created to make health insurance more accessible, affordable, and higher in quality for Americans.

Before the ACA, many people struggled to get or afford health insurance, especially those with pre-existing conditions. Obamacare helped reduce the number of uninsured people in the U.S.

ACA plans are available through the Marketplace (or Exchange). Individuals and families can choose an ACA plan instead of one from an employer or a private insurer. Pre-existing conditions don’t prevent anyone from enrolling, and many people qualify for financial help to lower their monthly costs.

Every ACA plan is required to cover the ten Essential Health Benefits (EHBs). These ten benefits include:

● Hospitalization

● Emergency services

● Ambulatory services

● Prescription drugs

● Maternity and newborn care

● Mental health and substance abuse services

● Lab tests

● Chronic disease management, preventive, and “well” services

● Pediatric dental and vision care

● Rehabilitative services

HMO vs PPO: Which Insurance Plan Is Right for You?

When choosing a health insurance plan, it's important to understand the differences between an HMO (Health Maintenance Organization) and a PPO (Preferred Provider Organization). Each has its pros and cons, depending on your healthcare needs and budget.


HMO (Health Maintenance Organization)

✔ Lower costs – Usually lower monthly premiums and out-of-pocket expenses

✔ Primary care required – You must choose a primary care doctor (PCP) who coordinates your care

✔ Referrals needed – You need a referral from your PCP to see a specialist
✘ Limited network – You must use doctors and hospitals within the plan’s network (except in emergencies)


PPO (Preferred Provider Organization)

✔ More flexibility – You can see any doctor or specialist, even outside the network

✔ No referrals needed – You don’t need permission to see a specialist

✔ Larger network – More provider choices for care

✘ Higher costs – Usually higher premiums and out-of-pocket expenses


Which Plan Is Right for You?

Choose an HMO if you want lower costs and don’t mind using a set network of doctors.

Choose a PPO if you prefer flexibility and want the freedom to see any provider without referrals.

Still unsure? Our team can help you compare plans and find the best fit for your needs!

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How Much Do ACA Plans Cost?

The Affordable Care Act (ACA) didn’t just create new health insurance options—it also made Medicaid available to more people, stopped insurance companies from denying coverage for pre-existing conditions, and provided financial help for those with lower incomes.

Premium tax credits can reduce your monthly insurance costs, but eligibility depends on your income. When applying, you'll need to share your income details to see if you qualify.

In addition to premiums, you may have costs like deductibles, copays, and coinsurance, which vary by plan. ACA plans come in four levels: Platinum (highest coverage), Gold, Silver, and Bronze (lower monthly costs but higher out-of-pocket expenses).

When Can I Enroll?

You can sign up for an ACA health plan during the Open Enrollment Period, which usually runs from November 1 to January 15 in most states.

If you miss this window, you may still qualify for a Special Enrollment Period (SEP) if you have a major life event, such as:


✔ Losing health coverage
✔ Getting married or divorced
✔ Having a baby or adopting a child
✔ Moving to a new area
✔ A change in income that affects your eligibility


Medicaid and the Children's Health Insurance Program (CHIP) are available year-round for those who qualify.

Looking for

HEALTH INSURACE?

There are many health insurance options available for individuals and families, including marketplace plans, employer-sponsored coverage, and government programs like Medicaid and Medicare.

Our licensed agents can help you compare plans, understand costs, and find the best coverage for your needs. Let us know how we can assist you!

ADDITIONAL QUESTIONS TO BE ADVISED ON:

How do I know if my doctor is in-network?

To see if your doctor is in-network, check your insurance company’s website, call their customer service, or ask your doctor’s office. This helps you avoid extra costs.

Are prescription drugs covered under my plan?

Prescription drugs are usually covered, but the specific medications and costs depend on your plan. You can check your plan’s drug list (formulary) on your insurance company’s website or call their customer service to confirm coverage and costs.

What preventive services are included for free?

Most ACA health plans cover free preventive services like vaccinations, annual check-ups, cancer screenings, and wellness visits. You can check your plan details or ask your insurance provider to see which services are included.

Am I eligible for any subsidies or tax credits to lower my costs?

You may qualify for subsidies or tax credits based on your income, household size, and where you live. You can check your eligibility by applying through the ACA Marketplace or using an online subsidy calculator.

What are the differences between Bronze, Silver, Gold, and Platinum plans?

Bronze – Lowest monthly premium, highest out-of-pocket costs, good for those who rarely need medical care.

Silver – Moderate premium and out-of-pocket costs, a balanced choice, and eligible for extra savings if you qualify.

Gold – Higher premium but lower out-of-pocket costs, ideal if you need frequent medical care.

Platinum – Highest premium but lowest out-of-pocket costs, best if you need a lot of medical care.

Silver plans may offer extra savings for those who qualify based on income.

We are not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area, and any information we provide is limited to those plans we do offer in your area. Please get in touch with Medicare.gov or 1-800-MEDICARE to get information on all your options.

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