Affordable Care Act (ACA) Plans

How ACA Plans Work

The Health Insurance Marketplaces were formed to offer individuals and small businesses a one-stop shop to compare and get health insurance plans.

The available plans vary based on state. Some states run through a state-run marketplace while others use the federal marketplace.

Features

ACA Plans have to:

  • Meet specific cost-sharing requirements

  • Have limits on out-of-pocket expenses

How to compare plans

When shopping for a plan, people can compare different health insurance options based on the level of coverage, monthly premiums, and out-of-pocket costs. Typically, these plans are put into different categories and placed into four levels: Bronze, Silver, Gold, and Platinum, each offering a wide variety of benefits and level of protection. 

Benefits

ACA Plans offer a set of health benefits, which include, but not limited to:

  • Preventive care

  • Prescription drug coverage

  • Emergency services

  • Hospitalization

  • Mental health services

What to Consider When Selecting a Plan

When selecting an ACA plan on the marketplace, it's important to keep in mind the following aspects: 

  • This is the cost you pay each month for a plan. Higher premiums usually result lower out-of-pocket costs, while lower premiums result higher out-of-pocket costs.

  • This is the amount you pay and are responsible for before the insurance kicks in. Policies with higher deductibles typically have lower monthly premiums, but not always.

  • Copayments are set amounts you pay for different services, while coinsurance is a percentage of the total cost of care. It's important to realize these costs and how they affect your overall healthcare costs.

  • Health insurance plans have a network of providers, and it's important to check whether your favorite doctors, hospitals, and clinics are included in the plan's network.

  • Check if the plan covers the medications you need and if there are any limitations or obstacles to get them filled.

  • This is the most you will pay out-of-pocket for covered healthcare services during a plan year. It's vital to know the out-of-pocket max, so you can plan for any unexpected medical expenses.