ACA Health Insurance
Understanding Affordable Care Act coverage.
A plain-language overview of how Marketplace health plans work, so you can make informed decisions.
What is ACA health insurance?
ACA health insurance refers to individual and family plans that meet Affordable Care Act standards. These plans are available through the Health Insurance Marketplace, cannot deny coverage because of pre-existing conditions, and include essential health benefits.
What do ACA plans typically cover?
Marketplace plans generally include these essential health benefit categories. Specific coverage details vary by plan.
- Outpatient care
- Emergency services
- Hospitalization
- Pregnancy, maternity & newborn care
- Mental health & substance use services
- Prescription drugs
- Rehabilitative services
- Laboratory services
- Preventive & wellness care
- Pediatric services
Understanding plan categories
Metal categories describe how costs are shared between you and your plan, not the quality of care.
Bronze
Silver
Gold
Platinum
Understanding your costs
- Premiums
- Your monthly payment for coverage.
- Deductibles
- What you pay before the plan begins sharing costs.
- Copays
- A fixed amount for a visit or prescription.
- Coinsurance
- A percentage of costs you share after the deductible.
- Provider networks
- The doctors, hospitals, and pharmacies a plan contracts with.
- Out-of-pocket costs
- Your total spending on covered care, up to an annual maximum.
Comparing plans
The lowest premium isn't always the lowest total cost. When comparing plans, consider your expected care, your doctors and prescriptions, and how deductibles and out-of-pocket maximums affect your budget. We help you look at the full picture.
Financial assistance
Many households qualify for premium tax credits that lower monthly costs, and some may qualify for cost-sharing reductions. Eligibility depends on factors like household size and expected income and is determined through the Marketplace application.
Have questions about your coverage options?
Talk with Marketplace Advisors. We'll walk through your options in plain language.