Affordable Care Act (ACA)

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Key features and how it works

Marketplaces: The ACA created state and federal health insurance marketplaces (also known as exchanges) where individuals can explore ACA insurance options and enroll in private health insurance plans. 

Subsidies: Many individuals who purchase ACA plans qualify for financial assistance, such as the Premium Tax Credit, which reduces the monthly premium costs based on income. 

Essential Health Benefits: Every ACA-compliant plan is required to cover a comprehensive set of 10 essential health benefits. 

Pre-existing Conditions: Insurers are prohibited from denying coverage or charging higher rates due to pre-existing conditions. 

Preventive Care: Plans must provide certain preventive services, including screenings and immunizations, at no cost to the consumer. 

No Annual/Lifetime Limits: There are no annual or lifetime limits on the coverage of essential health benefits.

Who is eligible

To qualify for an ACA plan, you must live in the United States. 

You need to be a U.S. citizen or national, or be lawfully present. 

You cannot be incarcerated. 

Eligibility for Medicare or other government programs like Medicaid may affect your access, though some health insurance marketplaces offer options that include Medicaid.

How to choose a plan

Compare plans: Evaluate the costs, including premiums and out-of-pocket expenses, as well as the network of doctors and hospitals available. 

Consider your needs: Select a plan that suits your budget and medical requirements, noting that lower-premium plans typically come with higher deductibles. 

Look for subsidies: You might qualify for subsidies that can significantly reduce your monthly premium and out-of-pocket costs. 

Be aware of what's covered: All plans include the 10 essential health benefits, but the specifics of coverage can differ by plan and state.