top of page

Affordable Care Act

What is ACA Insurance?

​

ACA insurance typically refers to health insurance plans that comply with the provisions of the Affordable Care Act (ACA). These plans are offered through the Health Insurance Marketplaces established by the ACA or through private insurance companies that adhere to ACA regulations.

​

Here are some key features of ACA-compliant insurance plans:

 

  • Coverage Requirements: ACA-compliant plans must cover a set of essential health benefits, including preventive services, maternity care, prescription drugs, mental health services, and hospitalization. These plans must also provide coverage for pre-existing conditions and cannot impose annual or lifetime limits on essential benefits.

 

  • No Discrimination: ACA-compliant plans cannot discriminate against individuals based on health status, gender, age, or pre-existing conditions. Insurers cannot deny coverage, charge higher premiums, or exclude coverage for specific conditions based on an individuals health history.

 

  • Metal Tiers: ACA-compliant plans are categorized into metal tiers based on their actuarial value, which represents the percentage of healthcare costs covered by the plan on average. The metal tiers include Bronze (covers about 60% of costs), Silver (70%), Gold (80%), and Platinum (90%). Catastrophic plans are also available for certain eligible individuals under age 30 or with hardship exemptions.

 

  • Cost-Sharing Limits: ACA-compliant plans have limits on out-of-pocket costs, including deductibles, copayments, and coinsurance. These limits are adjusted annually and are designed to protect consumers from high medical expenses.

 

  • Subsidies and Financial Assistance: Individuals and families with low to moderate incomes may be eligible for premium tax credits and cost-sharing reductions to help lower the cost of ACA-compliant insurance plans purchased through the Health Insurance Marketplaces. These subsidies are based on income and household size and can significantly reduce monthly premiums and out-of-pocket costs.

 

  • Coverage Enrollment Periods: ACA-compliant insurance plans are typically available for purchase during the annual open enrollment period, which runs from November 1st to December 15th each year. Special enrollment periods are also available for individuals who experience qualifying life events, such as marriage, birth or adoption of a child, loss of other health coverage, or relocation. ACA-compliant insurance plans offer comprehensive coverage and consumer protections to individuals and families, ensuring access to essential healthcare services and financial security against high medical costs. It is important for consumers to compare plan options, understand their coverage needs, and take advantage of available subsidies and financial assistance when selecting an ACA-compliant insurance plan.

​

​

This site is not affiliated with or endorsed by the government or federal Medicare program. 

Participating sales agencies represent Medicare Advantage [HMO, PPO, PFFS, and PDP] organizations that are contracted with Medicare. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan in your area. Please contact medicare.gov or 1-800-Medicare to get information on all your options.

​

bottom of page