Health Coverage Resources
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ACA Enrollment Checklist 
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ACA Enrollment FAQ 
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Health Insurance Terms 
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Understanding ACA Metal Plans 
Finding the Right Plan for Each Individual and Family
Healthcare isn’t one size fits all. That’s why it is important to get the plan that is the best fit for each individual or family.
Our Affordable Care Act (ACA)-licensed insurance benefits experts take the time to listen to what’s important to you.  Then we look for affordable plans available in your area that meet those unique medical and lifestyle needs. We also check to see if you are eligible for tax credits to lower your monthly costs.
And we are here for you year-round, to answer your insurance questions and advocate on your behalf. Often, you can speak with the same expert who enrolled you in your plan.
Need help comparing costs of plans in your area? Call our ACA experts: 
1-800-550-8246
TIPS TO HELP YOU CHOOSE THE RIGHT ACA HEALTH PLAN
Getting the coverage you need at an affordable price is important. Here are some things you should know before choosing a plan for you or your family.
WHAT WE PROVIDE
Affordable Care Act
Affordable ACA Health Insurance
If your annual income is below 150% of the federal poverty limit, you are eligible for zero-premium coverage, depending on what plan you pick. In 2022 the limit is:
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$20,385 for an individual 
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$27,465 for a couple 
If your income is between 150% and 400% of the federal poverty level, you are eligible for premium subsidies. The amount of the subsidy depends your income and what plan you pick.
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$54,360 for an individual 
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$73,240 for a couple 
If your income is above 400% of the federal poverty level, you are eligible for subsidies if your premium payments would be more than 8.5 percent of your income.
Affordable Care Act
What Will My ACA Health Plan Cover?
All ACA health plans cover 10 essential health benefits:
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Ambulatory patient services (outpatient care you get without being admitted to a hospital) 
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Emergency services 
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Hospitalization (like surgery and overnight stays) 
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Pregnancy, maternity, and newborn care (both before and after birth) 
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Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy) 
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Prescription drugs 
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Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills) 
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Laboratory services 
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Preventive and wellness services and chronic disease management 
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Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits) 
Affordable Care Act
Adult Dental and Vision Coverage
Dental and vision coverage are not considered essential health benefits for adults. Some plans do cover vision and dental care, so check your plan.
We Can Help you Enroll in a Dental or Vision Plan
If You Have a Pre-existing Medical Condition
All ACA marketplace plans, unless grandfathered, must cover treatment for pre-existing medical conditions:
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No ACA insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any conditions you had before your coverage started. 
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Once you’re enrolled, the plan can’t deny you coverage or raise your rates based only on your health. 
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If you’re pregnant, coverage starts the day your plan starts. 
Grandfathered plans don’t have to cover pre-existing conditions. If you have been enrolled in the same plan since before March 23, 2010, you could be in a grandfathered plan that doesn’t have to cover pre-existing conditions or preventive care.
Pre-existing mental and behavioral health conditions
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Your ACA plan can’t deny you coverage or charge you more for any pre-existing condition, including mental health and substance use disorder conditions. 
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Coverage for treatment of all pre-existing conditions begins the day your coverage starts. 
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Your plan can’t put yearly or lifetime dollar limits on coverage of any essential health benefit, including mental health and substance use disorder services. 
Affordable Care Act
Pregnancy Care
f you’re pregnant when you apply, your plan can’t reject you or charge you more because of your pregnancy. Pregnancy and childbirth coverage begins the day your plan starts.
Your plan must also provide breastfeeding support, counseling, and equipment for as long as you breastfeed your child. These services may be provided before and after birth.
Birth Control
ACA health plans must cover contraceptive methods and counseling for all women, as prescribed by a health care provider.
Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider, even if you haven’t met your deductible.
Preventive Health Services
Your ACA health plan must cover services to find and prevent diseases and health problems before they get worse. These services include shots and screening tests.
Visit healthcare.gov to get see what’s covered:
Mental Health and Substance Abuse
Mental and behavioral health services are essential health benefits All plans must cover:
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Behavioral health treatment, such as psychotherapy and counseling 
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Mental and behavioral health inpatient services 
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Substance use disorder (commonly known as substance abuse) treatment 
Your specific behavioral health benefits will depend on the state you live in and the health plan you choose. Phoenix Alliance can help you compare plans available to you to see what mental health and substance abuse services are covered.

