The Affordable Care Act (ACA) is a comprehensive reform law, enacted in 2010, that increases health insurance coverage for the uninsured and implements reforms to the health insurance market. 

Open enrollment is the annual period for Americans to make selections for healthcare coverage for themselves and their family members. Typically running from November 1st to December 15th every year, Open-Enrollment gives US citizens 45 days to review available options and enroll in plans for medical, dental, vision, flexible spending accounts, life insurance, and more. 

A Provider Network is a list of the doctors, other health care providers, and hospitals that a plan contracts with to provide medical care to its members. These providers are called “network providers” or “in-network providers.” A provider that isn’t contracted with the plan is called an “out-of-network provider.” 

Depending on the type of plan you buy, your plan may cover your care only when you see a network provider. You may have to pay more, and/or get a referral if you choose to get care from a provider who isn’t in your plan’s network. Types of plans include: 

• Preferred Provider Organizations (PPOs): You pay less if you use providers in the plan’s network. For an additional cost, you can use doctors, hospitals, and providers outside of the network without a referral.

• Point-of-Service (POS) Plans: You pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You’re required to get referrals from your primary care doctor to see specialists.

• Health Maintenance Organizations (HMOs): You’re usually limited to care from doctors who work for or contract with the HMO and aren’t covered for out-of-network care (except in an emergency). You may be required to live or work in the HMO’s service area to be eligible for coverage.

• Exclusive Provider Organizations (EPOs): You’re only covered if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency 

A copayment or copay is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service. It may be defined in an insurance policy and paid by an insured person each time a medical service is accessed. 

A subsidy is a credit the government applies to your health insurance premiums each month to make them affordable. Essentially, the government pays part of your premium directly to your health insurance company, and you're responsible for the rest.

As part of the American Rescue Plan Act, subsidies have increased for lower-income Americans and extended to those with higher incomes. The ARPA expanded marketplace subsidies above 400% of the poverty level and increased subsidies for those making between 100% and 400% of the poverty level. See (ARPA) FAQs to learn more.

You can take your advance premium tax credit in one of three ways: equal amounts each month; more in some months and less in others, which is helpful if your income is irregular; or as a credit against your income tax liability when you file your annual tax return, which could mean you owe less tax or get a bigger refund. The tax credit is designed to make premiums affordable based on your household size and income.

Your credit is based on your estimated income for the year, so if your income or household size changes during the year, it's a good idea to update your information right away so your premium credits can be adjusted accordingly. That way, you won't have any unpleasant surprises at tax time, nor will you pay higher premiums than you need to throughout the year.

If you miss the annual enrollment period and don't have one of the reasons that qualify you for a Special-Enrollment Period, you may have to resort to buying a short-term health insurance plan that typically lasts anywhere from three months to 364 days. These plans are low-cost, but they have limited benefits and usually do not cover any pre existing conditions.

Buyer beware: Regulations vary by state, but in general, you can expect that pre-existing conditions won't be covered; your application may not even be accepted if you have certain health problems. Other common exclusions include maternity care, mental health services, and prescription drugs. And be on the lookout for dollar limits on coverage. Short-term plans don't offer the same protections that exchange plans do and may not help enough or at all when you need coverage the most.

You might have heard of something called Health Care Sharing Ministries. First, understand that these are not technically “health insurance.” It’s more like a group of people who belong to an organization like a church or ministry who pool their money together into a fund. They use this fund to pay for major health care costs for members in the group.

This might sound like a good option if you’re healthy with no dependents, but there are downsides. There are restrictions on what the ministry might agree to pay for. During the review of the summary of benefits for these plans you will see clearly stated that these plans are not to be considered health insurance and that the policy holder is responsible for any and all medical claims that may arise. Whether or not your claim is paid is based solely on the discretion of its members, and is 100% voluntary. Also, ministries are not regulated by the Affordable Care Act, which means they’re not required to cover your pre-existing conditions.

The amount you pay depends on your income and the rules in your specific state. Additionally, some specific groups under Medicaid are exempt from many out-of-pocket costs. 

How much you pay will vary based on when you enroll, what coverage options you select and what health services and items you use throughout the year.

There are also four different Medicare Savings Programs, which are designed to help with the cost of Medicare. If you meet the conditions to qualify for one of these programs, you could get help paying for your Medicare premiums, and in some cases, also get help paying Medicare Part A and Part B deductibles, coinsurance and copayments. 

Insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance. In some states, CHIP covers pregnant women.

Each state offers CHIP coverage and works closely with its state Medicaid program. You can apply any time. If you qualify, your coverage can begin immediately, any time of year.

Getting Healthcare Marketplace Coverage for your employees through a Small-Business can be more affordable than buying coverage by yourself. Here's what you need to know:

• Coverage is generally guaranteed issue

• You need at least one employee to qualify

• You must contribute toward employee premiums

• And you can shop for coverage at any time of the year

Getting Healthcare Coverage through private companies can be much more affordable and much stronger than Marketplace options IF individuals are able to qualify. These flexible cost options offer many advantages over traditional group plans:

• Remote employees can pick plans in their area, even if it's a different location than their employer

• There are no minimum participation requirements. Employees can waive coverage if they wish

• Employees can enroll outside of the federal Open-Enrollment period.

• All employees can participate, even part-time and seasonal workers

• Gives employers freedom to control costs and there are no limits to how much an employer can reimburse

• More options means employees can choose plans and doctors that work for them

• Employees can keep their plan if they change jobs, the only change would be employer reimbursement

An Individual Coverage Health Reimbursement Arrangement (ICHRA) is an option that allows organizations of all sizes to reimburse their employees, tax-free, for their individual health insurance premiums and potentially other qualifying medical expenses. 

YES! If you already have a broker or have purchased a health plan in the past through a broker or health insurance company, JSR Health Consultants can help you to maintain your current plan or find a new plan that meets your health insurance needs!

In addition:

• JSR provides you with world-class customer service

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• JSR has dedicated health advisors on the ready to field your questions

• Rates are regulated and do not vary by broker, so there's no additional cost to you!