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Affordable Care Act (ACA)

Health Insurance Options for Individuals and Families

The Health Insurance Marketplace offers ACA-compliant plans and determines whether applicants qualify for premium tax credits or other financial assistance.

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How ACA Marketplace Coverage Works

Marketplace plans include consumer protections established by the Affordable Care Act. Eligibility for financial assistance depends on the information provided in a Marketplace application.

Financial Assistance May Be Available

Depending on your household information and estimated income, you may qualify for a premium tax credit. Some applicants may also qualify for cost-sharing reductions when enrolled in a Silver plan.

Pre-Existing Condition Protections

Marketplace plans cannot deny coverage or charge a higher premium because of a pre-existing condition.

Required Coverage Categories

Plans sold on the ACA Marketplace must include 10 required coverage categories, such as prescription drugs, mental health services, and maternity care.

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How the Health Insurance Market Changed

Before the Affordable Care Act, finding coverage was more difficult for many people, particularly those with pre-existing conditions.

Common problems included:

Coverage could be denied because of a pre-existing condition.
Premiums could vary based on an applicant’s health history.
Consumer protections against certain coverage cancellations were more limited.

The ACA changed the individual health insurance market by establishing rules for individual health coverage, including protections for pre-existing conditions and required categories of covered care.

Compare Marketplace Plan Categories

Marketplace plans are grouped into Bronze, Silver, Gold, and Platinum categories. Catastrophic plans may also be available to certain eligible applicants. Categories describe how you and the plan generally share costs, not the quality of care.

Bronze & Silver Plans

Bronze plans generally have lower monthly premiums and higher costs when you receive care. Silver plans generally fall between Bronze and Gold, and cost-sharing reductions are available only with Silver plans.

✔ Premiums, deductibles, copayments, and coinsurance vary by plan.
✔ Provider networks and covered prescription drugs also vary by plan.
✔ Cost-sharing reductions apply only when an eligible applicant enrolls in a Silver plan.

Gold & Platinum Plans

Gold and Platinum plans generally have higher monthly premiums and lower costs when you receive covered care. Actual costs and availability vary by plan and location.

✔ Compare the total estimated yearly cost, not only the monthly premium.
✔ Review provider networks and prescription drug coverage before enrolling.
✔ Metal categories describe cost sharing, not the quality of care.

Ready to Review ACA Plan Options?

Our licensed insurance agents can help you review Marketplace plans and understand the financial-assistance information shown in your Marketplace eligibility results.

Provide Your Information

Provide the household and estimated-income information needed for the Marketplace application. The Marketplace determines eligibility for coverage and financial assistance.

Review Your Options

We’ll review available plans offered through the carriers we represent and explain premiums, deductibles, networks, and covered services.

Review Enrollment Steps

Once you choose a plan, we’ll guide you through the application and enrollment process end-to-end.

Request a Quote

Got questions? We've got answers.

If you don't see your question below, call to talk with a licensed insurance agent.

Who is eligible to enroll in an ACA plan?

To enroll through the Marketplace, you generally must live in the United States, be a U.S. citizen or national or be lawfully present, and not be incarcerated. If you have Medicare, you cannot enroll in a Marketplace health or dental plan. Eligibility for premium tax credits and other financial assistance depends on the information in your Marketplace application.

What is a Qualifying Life Event?

A Qualifying Life Event (QLE) is a major life change that makes you eligible for a Special Enrollment Period outside of Open Enrollment, for example: losing job-based coverage, getting married, or having a baby.

What is a subsidy or tax credit?

A premium tax credit can lower your monthly premium and may be paid directly to the insurance company. The Marketplace determines eligibility and the amount using information in your application, including household size and estimated income.

Do ACA plans cover pre-existing conditions?

Yes. The ACA prohibits insurers from denying coverage or charging more because of a pre-existing condition.

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