All ACA-compliant health insurance plans cover a wide range of preventive services, including annual checkups, screenings, and vaccinations, at no cost to you when using an in-network provider. For help accessing preventive care or finding in-network providers, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

All ACA health plans cover prescription drugs, but coverage and costs vary depending on your plan’s formulary (list of covered medications). To find out which drugs are covered and what you’ll pay, review your plan’s formulary or contact your insurance provider. For assistance, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

Mental health and substance abuse treatments are fully covered by all ACA-compliant plans. This includes services like therapy, inpatient treatment, and medications. ACA plans are required to offer parity, meaning mental health services must be covered at the same level as physical health services. For help finding in-network providers or understanding your coverage, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

All ACA health insurance plans cover prenatal, maternity, and newborn care. This includes prenatal visits, screenings, labor and delivery, and routine care for your baby. Preventive services like prenatal checkups are covered at no cost to you when using in-network providers. For help understanding your maternity coverage, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

Emergency room visits are covered by all ACA health plans, whether you visit an in-network or out-of-network hospital. However, the cost will depend on your plan’s deductible, copayments, and coinsurance. Emergency care counts toward your out-of-pocket maximum, providing financial protection. To understand your ER coverage, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

You can see a specialist with your ACA health insurance, but whether you need a referral depends on your plan type. HMO and POS plans usually require a referral, while PPO and EPO plans do not. To explore your specialist options or get help with referrals, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

You can find the list of prescription drugs covered by your ACA plan (called a formulary) on your insurer’s website or the ACA Marketplace. This list shows which medications are covered and how much you’ll pay based on drug tiers. For help accessing your formulary, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

Depending on your ACA plan, you may or may not need to meet your deductible before your prescription drug coverage begins. Lower-cost medications like generic drugs are often covered immediately with a copayment, while higher-tier medications may require you to meet the deductible first. For more information, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

If the prescription drugs you need aren’t covered by your ACA plan, you can request a formulary exception, file an appeal, or explore discount programs and manufacturer coupons. You can also consider switching to a plan that better suits your needs during Open Enrollment. For more help, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

Both generic and brand-name prescription medications are covered by your ACA plan, but the costs vary based on the drug’s tier in your plan’s formulary. Generic drugs in Tier 1 tend to have lower costs, while brand-name drugs in Tier 2 or Tier 3 may require higher copayments or coinsurance. For help checking if your medications are covered, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

How much you’ll pay for prescription drugs under your ACA insurance depends on the medication’s tier, whether you’ve met your deductible, and your plan’s cost-sharing. Generic drugs usually have low copayments, while brand-name and specialty drugs may have higher coinsurance costs. For help, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

You cannot have both Medicaid and an ACA health insurance plan at the same time. If you qualify for Medicaid based on your income, you’ll be enrolled in that program instead of purchasing an ACA plan. For help with eligibility, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

If you become eligible for Medicare, you’ll need to transition from your ACA health insurance plan to Medicare, as the two programs don’t coordinate. Continuing an ACA plan after qualifying for Medicare will result in the loss of subsidies. For more guidance on making the transition, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

You can technically have both ACA health insurance and employer-provided coverage, but it’s usually not recommended because you’ll lose access to ACA subsidies if your employer’s plan meets affordability standards. This can result in higher overall costs without adding significant benefits. For help deciding between your employer’s plan and ACA options, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

You can purchase an ACA plan while being covered by your spouse’s employer plan, but you’ll likely lose eligibility for subsidies if the employer coverage is deemed affordable. This can lead to higher costs without significant benefits. For help comparing options, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

You can purchase an ACA plan even if you’re covered by your spouse’s employer-sponsored health insurance, but you may not qualify for subsidies if your spouse’s plan is considered affordable. For help determining the best coverage option, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

If you gain access to employer-sponsored health insurance during the year, you can leave your ACA plan during a Special Enrollment Period. However, you may lose your ACA subsidies, making the plan more expensive. For help switching plans, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

If you lose your job, you qualify for a Special Enrollment Period to sign up for an ACA plan. Depending on your income, you may also be eligible for premium tax credits and cost-sharing reductions. For assistance with enrollment, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

If you relocate to a new state, you’ll need to enroll in a new ACA health insurance plan because ACA plans are state-specific. Moving qualifies you for a Special Enrollment Period (SEP), allowing you to choose a new plan within 60 days. For assistance with switching plans, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

Getting married qualifies you for a Special Enrollment Period, allowing you to change or update your ACA health insurance. You can enroll in a new plan together, add your spouse to your plan, or switch to your spouse’s plan within 60 days. For help updating your coverage, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.