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Let's go over how coverage works.

How comfortable are you navigating Affordable Care Act (ACA) insurance ... or insurance at all?

No matter where you’re at, we’ve covered what you need to know for open enrollment on November 1. 

Is ACA coverage right for you?

If you don’t have insurance through your job or a government program like Medicare, take a look at ACA Individual and Family plans. They’re available for almost everyone. And they can help you take care of your most important asset — you.

I work at a part-time job that doesn’t offer insurance.

You don’t need to work full-time to get ACA coverage. Your income may even qualify you for a premium discount and extra savings.

I lost my job and my health insurance coverage. 

You’ve got options. One of them is COBRA. But this coverage typically runs out after 18 months, and it can be pricey. The good news is that ACA coverage typically costs less. 

I run my own business, but I don’t have employees.

With ACA coverage, you can choose the premium and out-of-pocket costs that are right for you. You may even be able to deduct the premiums you paid on your income tax.

I’m a freelancer, gig worker or consultant.

With lots of ACA plan choices available, you get to choose what best fits you. And since you’re self-employed, you may even get a tax break on your premiums.

I work at a part-time job that offers insurance.

You can still buy an ACA plan. But if your employer’s plan meets certain affordability and quality standards, you may pay less for employer coverage than an ACA plan.

I’m retired, but not old enough for Medicare.

With ACA coverage, you’ll find many plan options and you may even qualify for financial help to lower your costs. Plus, everyone who applies can’t be denied coverage for preexisting conditions.

Let’s dig into ACA coverage

What ACA plans cover

All ACA individual and family plans must cover 10 essential benefits like hospitalization, preventive care and mental health services. Some plans offer extras like dental and vision. 

ACA plan levels

Every plan is assigned what is known as a metal tier: Platinum, Gold, Silver or Bronze. Metal tiers have nothing to with the quality of care you receive. They determine how you and your plan split costs.

On or off the marketplace

You can apply for ACA coverage and financial help through companies with direct enrollment sites, like us, or on the federal marketplace. If you shop off the marketplace, you won’t get financial help.

Saving money on your plan

When you enroll in a plan on the marketplace, you may be eligible for discounts on your monthly bill or extra savings on your out-of-pocket medical costs.

The top insurance terms you'll want to know.

Let's go over some common insurance terms you might see during your coverage search.

Copay

This is a fixed amount that you typically pay at the time you get care. For example, you might pay $40 when you see your doctor.

Deductible

This is the amount you pay before your plan starts to pay for some or all of your costs. 

Coinsurance

This is a percentage that you pay after you’ve met your deductible. For example, if your plan covers 80% of the cost for physical therapy, you would pay the remaining 20%. 

Out-of-pocket maximum

This is a cap on your plan costs. Once you have paid this amount through your deductible, copays and coinsurance, your plan pays 100% of all covered costs for the rest of the plan year.

Referral

This is an order from your provider, written on paper or sent electronically, to see another provider or for a specific health service.

Network

This is a group of providers — like doctors and clinics — that have a contract with a health plan. When you see a provider in your health plan’s network you get special, lower rates.

Save the date: ACA enrollment periods 

When is the Open Enrollment Period?

The time to choose an ACA individual and family plan is right around the corner. The Open Enrollment Period for 2022 opens on November 1, 2021 and ends on January 15, 2022. Enroll by December 15, 2021 for coverage that starts January 1, 2022. 

The Open Enrollment Period is the time of year when you can explore plan options, see if your doctor participates in the plan, apply for financial help and purchase health plan coverage.  So you don’t want to miss out.

If I miss the deadline, can I still sign up for ACA coverage? 

Life won’t wait for Open Enrollment.  So certain life events — called qualifying events — let you sign up for coverage outside the typical Open Enrollment window. 

What’s an example of a qualifying life event? 

Maybe you no longer have health care coverage because you’ve lost your job. Or maybe you’re getting married or having a baby or moving to a new state. These life events — and others — all give you the right to sign up for a health plan outside the Open Enrollment Period as long as you do so no more than 60 days after the event. 

Transforming health care, together

Banner|Aetna aims to offer more efficient and effective member care at a more affordable cost. We join the right medical professionals with the right technology, so members benefit from quality, personalized health care designed to help them reach their health ambitions.

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Health benefits and health insurance plans are offered, underwritten, and/or administered by Banner Health and Aetna Health Insurance Company and/or Banner Health and Aetna Health Plan Inc. (Banner|Aetna). Banner|Aetna is an affiliate of Banner Health and of Aetna Life Insurance Company and its affiliates (Aetna). Each insurer has sole financial responsibility for its own products. Aetna and Banner Health provide certain management services to Banner|Aetna.  Aetna and CVS Pharmacy® are part of the CVS Health family of companies. Aetna and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are both within the CVS Health family.

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This material is for information only and is not an offer or invitation to contract. Providers are independent contractors and are not agents of Banner l Aetna. Provider participation may change without notice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change.

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