With individual and family plans from Balance Benefit Group, you'll find health insurance coverage with benefits designed with your unique needs in mind. Let's explore the options together.
The Affordable Care Act (ACA), often called Obamacare, helps make health insurance more affordable and accessible, especially for those with low to moderate incomes. We’re passionate about making this process easier for you!
Choosing the best ACA health plan for you can feel overwhelming, but and help you every step of the way.
The ACA offers four plan tiers to help individuals choose coverage that best suits their healthcare needs and budget. These tiers reflect the percentage of healthcare costs that the insurance covers versus what the enrollee pays. The difference between tiers is not the quality of the attention, but the amount of payment you will have to afford.
Covers about 60% of healthcare costs; you pay the remaining 40%.
Covers about 80% of healthcare costs; you pay the remaining 20%.
Covers about 70% of healthcare costs; you pay the remaining 30%.
Covers about 90% of healthcare costs; you pay the remaining 10%.
All ACA health insurance plans include 10 essential health benefits to make sure you have reliable, complete coverage when it comes to your health.
Access to medical services without requiring an overnight stay, including consultations, diagnostics, and minor procedures.
Immediate coverage for urgent medical care, including accidents, injuries, and sudden illnesses, ensuring fast and reliable treatment when you need it most.
Comprehensive coverage for in-patient treatments, surgeries, and extended care during hospital stays.
Support for prenatal, delivery, and postnatal care, ensuring the well-being of both mother and baby.
Coverage for therapy, counseling, and treatments to support emotional and psychological well-being.
Affordable access to medications prescribed by your healthcare provider to manage or treat conditions.
Therapies to recover strength and function after illness, injury, or surgery, including physical and occupational therapy.
Comprehensive diagnostic testing services, including blood work and imaging, to aid accurate medical assessments.
Focus on staying healthy with routine screenings, wellness exams, and immunizations.
Specialized care for children, including regular checkups, vaccinations, and growth monitoring.
When selecting a health insurance plan, it’s essential to understand the different costs involved. These include your monthly premium, deductible, copayments, coinsurance, and out-of-pocket maximum.
This is the fixed amount you pay each month to keep your health insurance active, regardless of whether you use services.
A set amount you pay for specific services, such as doctor visits or prescriptions. Copayments can vary by service and plan.
Once you’ve met your deductible, coinsurance is the percentage of the cost for a service you’re responsible for. The insurance covers the rest.
The amount you pay for covered services before your plan starts to share costs. After meeting your deductible, your plan helps cover services.
The maximum you’ll spend in a year for covered services. After reaching this limit, your insurance covers 100% of covered costs for that current year
Premium Tax Credits
Premium tax credits are subsidies that help lower your monthly insurance premium. If your household income meets certain levels, you may qualify for a larger credit. These credits can apply to any plan tier to help reduce your premium.
Cost-Sharing Reductions (CSRs)
CSRs are another subsidy that lowers what you pay for copays, coinsurance, and deductibles. These are available only on Silver plans and are income-based, making it easier to afford care when you need it.
Staying in-network allows you to benefit from the insurer’s negotiated rates. Even if you’re paying toward your deductible, you’ll pay less than out-of-network rates. Plus, all payments to in-network providers count toward your out-of-pocket maximum.
Know the Right Place for Care
For minor issues, visit an in-network primary care provider or use Virtual Urgent Care for quick advice on non-emergency issues. Save the emergency room for life-threatening situations only—this helps keep costs down.
Preventive services, like annual checkups, screenings, and vaccines, are covered at no cost when you go in-network. This proactive care can help you avoid costly treatments later and keep your health in check.
