What are Some Common ACA Pitfalls?

Here are some common pitfalls people encounter with Affordable Care Act (ACA) health plans and tips on how to avoid them:

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1. Underestimating Income for Subsidies

Many ACA plans offer subsidies to help lower your premiums based on your income. However, underestimating your income can result in receiving more subsidies than you're entitled to, which could mean paying back the excess when filing taxes.

How to avoid it:
Be as accurate as possible when estimating your income. If your income changes during the year, report it promptly to the marketplace to avoid subsidy discrepancies.

2. Not Understanding the Network Coverage

ACA plans often limit their coverage to certain networks of doctors, hospitals, and specialists. If you don’t check which providers are in-network, you may end up paying higher out-of-network fees.

How to avoid it:
Always check whether your preferred doctors and hospitals are in-network before choosing a plan. Use the plan’s network directory or ask your providers directly.

3. Ignoring Out-of-Pocket Costs

Focusing solely on monthly premiums is a common mistake. Plans with lower premiums often come with higher out-of-pocket costs, such as deductibles, copays, and coinsurance. These costs can add up quickly if you need medical care.

How to avoid it:
Look beyond the premium and evaluate the total cost, including deductibles and out-of-pocket maximums. Consider how often you’ll need healthcare and balance those costs with the premium.

4. Missing Enrollment Deadlines

The ACA has strict enrollment periods, and missing them can leave you without coverage for the entire year, unless you qualify for a Special Enrollment Period (SEP) due to life events like marriage, birth of a child, or job loss.

How to avoid it:
Mark the Open Enrollment Period on your calendar (typically from November 1 to December 15 for coverage starting January 1). Stay informed about deadlines and apply early to avoid delays.

5. Overlooking Prescription Drug Coverage

Not all ACA plans cover the same medications, and some plans may have higher costs for certain drugs. If you have regular prescriptions, this can impact your out-of-pocket costs significantly.

How to avoid it:
Check each plan’s formulary (the list of covered medications) to ensure your prescriptions are covered. Also, review any copay or coinsurance costs for prescription drugs to avoid surprises at the pharmacy.

Conclusion

​To avoid these common ACA pitfalls, it’s crucial to take the time to understand your options, carefully review the plan’s details, and stay informed throughout the enrollment process. This will help you choose the best plan for your needs and prevent unexpected costs down the line.