Don’t Let Missteps Cost You Coverage or Money
The Affordable Care Act (ACA) makes health coverage available to millions of Americans, but navigating the Marketplace can still be confusing. Between myths about who qualifies, misunderstandings about subsidies, and the sheer number of plan options, it’s easy to make mistakes that could cost you money – or worse, leave your family without the coverage you need.
In this article, we’ll cover the most common ACA mistakes individuals and families make and how you can avoid them to ensure you and your family have access to quality healthcare year after year.
Believing You Don’t Qualify for Coverage
Many people assume the ACA Marketplace is only for the unemployed or those with very low incomes. Others believe their household income is too high to qualify for help. In reality, almost anyone can buy coverage through the Marketplace.
How to avoid it: Always check your eligibility. Don’t rule yourself out — use the Marketplace calculator or work with an agent to see what you qualify for.
Skipping ACA Coverage Because of Myths
Families sometimes avoid ACA plans altogether because they’ve heard misleading claims like ACA plans don’t cover much, pre-existing conditions aren’t included, or it’s cheaper to go uninsured and pay a penalty.
The truth is that all ACA plans must cover essential health benefits (hospitalization, maternity, prescriptions, preventive care, etc.) and cannot deny you for pre-existing conditions. While the penalty for being uninsured is gone, skipping coverage leaves you exposed to potentially catastrophic medical bills.
How to avoid it: Don’t let myths steer you wrong. Review the plan details or talk with a licensed agent to see what’s really included.
Focusing Only on the Premium
It’s tempting to choose the plan with the lowest monthly premium, but that often means ignoring deductibles, copays, coinsurance, and the maximum out-of-pocket limit. A Bronze plan might save money up front but cost thousands more if your family ends up needing care. Paying a little more each month for a Silver or Gold plan could actually save you money long-term.
How to avoid it: Compare total cost, not just the premium. Look at your expected medical use, prescriptions, and the worst-case out-of-pocket scenario.
Not Checking Provider Networks
Many people assume their doctors and hospitals are automatically covered. In reality, ACA plans have different networks, and even if you recognize the insurance company’s name, your preferred doctors may not be included.
How to avoid it: Always check the provider directory or confirm with your doctor’s office. MBhealth advisors will verify your doctors and medications are covered before you enroll.
Forgetting About Prescription Coverage
Prescription coverage varies widely by plan, and it can be one of the most expensive surprises for families. A medication you rely on might not be covered at all, or it could fall into a higher cost tier that significantly increases your expenses.
Even when a drug is technically covered, the difference in tiers can mean paying a few dollars for one prescription and hundreds for another. For families with multiple prescriptions, these differences add up quickly and can completely change the affordability of a plan.
How to avoid it: Make a list of all medications and confirm coverage under the plan’s drug list. Don’t assume all plans cover all drugs.
Ignoring Cost-Sharing Reductions (CSRs)
Families who qualify for extra savings sometimes miss out because they don’t choose a Silver plan. CSRs are only available in the Silver tier and can drastically lower deductibles, copays, and out-of-pocket maximums. For many households, a Silver plan with CSR is more affordable overall than Bronze or Gold.
How to avoid it: If your income qualifies, always compare Silver CSR plans first.
Missing Open Enrollment or Special Enrollment Periods
Some people wait too long and miss their chance to sign up. The ACA Marketplace has strict deadlines, with open enrollment usually running from November 1 through January 15. Outside of this window, you can only enroll if you qualify for a Special Enrollment Period due to life events like marriage, birth, or loss of other coverage.
How to avoid it: Mark your calendar, and don’t wait until the last week. Work with an agent early in open enrollment to secure coverage on time.
Forgetting to Update Income and Household Changes
If you don’t update your Marketplace account when your income changes, if you get married or divorced, or if your household size shifts, your subsidy may no longer be accurate. This could mean you receive too much and owe it back at tax time, or that you receive too little and miss out on savings.
How to avoid it: Report changes as soon as they happen. An agent can help update your Marketplace application so your subsidies stay correct.
Overlooking the “Family Glitch” Fix
In the past, if your employer offered health coverage, your family was often disqualified from subsidies even if the family premium was unaffordable. Thanks to the recent “family glitch” fix, dependents can now qualify for ACA subsidies if the cost of adding them to an employer plan exceeds about 8–9% of their household income.
How to avoid it: Compare your costs. In many cases, it’s cheaper for dependents to enroll through the ACA while the employee stays on the work plan.
Going It Alone
The ACA rules and plan details can be overwhelming, with dozens of plan options, confusing subsidy calculations, and networks that vary from one plan to another. For many families, trying to figure it out by yourself means hours of research, second-guessing your choices, and a much higher chance of costly mistakes that could leave you without the coverage you need when it matters most.
How to avoid it: Work with a licensed agent like MBhealth. We’ll review your doctors, prescriptions, income, and budget — then match you with the plan that truly fits your family.
Get Expert Guidance from MBhealth
ACA coverage doesn’t have to be confusing. By learning the facts, avoiding common pitfalls, and reviewing your options carefully, you can secure affordable coverage for yourself and your family.
At MBhealth Insurance Agency, we’re here to help you piece together the healthcare puzzle. Call us at (314) 544-5400 or schedule your no obligation consultation to review your ACA options today.
