Thanks to the ACA, many Americans have access to comprehensive health insurance. Find out about cost, eligibility, deadlines and more.

1. What is the Affordable Care Act?
2. What types of plans are available under the Affordable Care Act?
3. What do Affordable Care Act plans cover?
4. What type of Affordable Care Act plan should I choose?
5. How much do Affordable Care Act plans cost?
6. How do you apply for an Affordable Care Act plan?
7. What’s the difference between the federal Health Insurance Marketplace and a state exchange?
8. Who’s eligible to enroll in Affordable Care Act plans?
9. When can I apply for an Affordable Care Act plan?
10. How long does Affordable Care Act coverage last?
11. What if my situation changes in the middle of the year?
12. Can I cancel my Affordable Care Act coverage in the middle of the year?
13. What if I get employer coverage during the time I’m enrolled in an Affordable Care Act plan?
14. Am I required to get Affordable Care Act coverage?

The government-enacted Affordable Care Act, or ACA, has changed health care for millions of Americans since it was signed into law in 2010. Learn what the law does, what health plans are available under it, and how you can apply.

What is the Affordable Care Act?

The Affordable Care Act — whose official name is the Patient Protection and Affordable Care Act — was fully implemented in 2014. You may also see it referred to as the ACA, the PPACA or Obamacare (after President Barack Obama, who championed it).

The legislation had 3 main goals:

• Make affordable health insurance available to more people
• Expand the Medicaid program
• Support improvements in the delivery of medical care to lower the costs of care

“The ACA has been successful,” says Katie Keith, an associate research professor at Georgetown University. It expanded coverage, and roughly 45 million people were enrolled in coverage through Medicaid expansion or the marketplaces as of March 2024.” (The marketplaces, also known as health insurance exchanges, are websites where you can buy health insurance.)

In early 2023, nearly a decade after implementation, the number of uninsured people in the United States dropped to an all-time low of 7.7%. From 2020 to early 2023, 6.3 million people gained health insurance coverage. Changes were largest among individuals with incomes below 100% of the federal poverty level and incomes between 200% and 400% of the federal poverty level.

Interested in a health insurance plan? Get more details now, or call a licensed insurance agent at 1-844-211-7730 to discuss your options.

What types of plans are available under the Affordable Care Act?

Historically, Americans have received health insurance through their employers, through Medicare (for people ages 65 and older, plus people with end-stage renal disease and/or certain disabilities) or through Medicaid (for lower-income people or those with disabilities). Under the ACA, private insurers, like UnitedHealthcare, offer individual and family plans to people who don’t have such coverage. Although individual plans existed before the ACA, the law added incentives that made them more affordable for many people.

ACA plans come in four “metal” categories — bronze, silver, gold and platinum — which vary based on how you and your insurance company split costs. A bronze plan, for example, may have the lowest monthly premium (the amount you pay each month for coverage) and the highest costs when you receive care.

These costs come in the form of deductibles (how much you pay out of pocket before your insurance pays the rest), copayments and coinsurance (fixed payments you make every time you receive health services) and out-of-pocket maximums (the most you’d have to pay for covered services in a plan year).

A platinum plan, on the other hand, will offer you the opposite of what a bronze one might: the highest monthly premiums and the lowest costs for care. Silver and gold, as you might expect, fall somewhere in the middle.

It’s important to note that the metal category you choose does not affect the quality of care you receive. The care you receive through a bronze plan is the same as you might receive through a platinum plan.

Catastrophic health plans are also available for some people, such as individuals under age 30. These pair low premiums with very high deductibles.

According to the Centers for Medicare & Medicaid Services, 85% of people chose either a bronze (31%) or a silver (54%) plan for 2022. Just 13% chose gold plans, 1% chose platinum, and less than 1% chose catastrophic coverage. (These percentages don’t total 100% due to rounding.)

What do Affordable Care Act plans cover?

All ACA plans must cover 10 essential health services:

• Outpatient care
• Emergency services
• Hospital care
• Pregnancy, maternity, and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription medications
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care

Plans must also offer coverage for birth control and breastfeeding.

“Folks have really come to expect this now, but pre-2014, when those major reforms kicked in, individual market plans didn’t cover prescription drugs, they didn’t cover maternity, and they often excluded preexisting conditions,” says Keith.

The ACA brought a host of other consumer protections as well. For example, you can’t be charged more based on your health status, there can’t be an annual or lifetime limit on your coverage, and you must have enough access to providers. Also, young adults up to age 26 can stay on their parents’ health insurance even if they’ve left home or are no longer students.

Beyond the basics, some plans offer additional benefits, including adult dental coverage, adult vision coverage and medical management programs. For example, marketplace plans through UnitedHealthcare may offer free virtual visits and online fitness classes.

Another way to get health insurance? Enter your ZIP code to search available plans, or call a licensed insurance agent at 1-844-211-7730.

What type of Affordable Care Act plan should I choose?

Before you pick a plan, think about what level of care you’ll likely need and whether you’ll be able to cover certain costs. If you rarely see your doctor and mostly want protection from the worst type of outcomes, a bronze plan might be a good option.

On the other hand, if you have chronic health conditions, such as cancer or type 2 diabetes, and see your doctor quite often, a gold plan might make more sense.

It’s also important to check whether the health care providers you use are in a plan’s network and how much the prescription medication you take will cost. Plans typically have a formulary, sometimes called a drug list, that groups medications into tiers with different cost-sharing amounts.

“There can be significant variation, depending on what folks need,” Keith says.

How much do Affordable Care Act plans cost?

There are 2 ways to look at cost. First, you’ll pay a monthly premium and out-of-pocket costs such as a copayment when you see a doctor or fill a prescription. As noted above, the balance between those costs may change depending on which type of plan you choose.

Second, you may be eligible for 2 subsidies (discounts provided by the government): a premium tax credit and cost-sharing reductions that lower your out-of-pocket costs. “Often, close to 90% of people are getting premium tax credits,” says Keith. “About 50% of enrollees also get cost-sharing reductions.” (You must choose a silver plan to be eligible for cost-sharing reductions, but not for a premium tax credit.)

For 2024, the average monthly premium was $602 for plans purchased through the federal marketplace. However, people eligible for premium tax credits paid an average premium of just $81. Of course, out-of-pocket costs will vary depending on how much care you receive.

Keith thinks many people focus too much on premiums rather than overall costs. “You might enroll in a bronze plan for $0 a month with a really high deductible, even though you would be better off enrolling in a silver plan, getting those cost-sharing reductions, paying a little something each month [in premiums], but then having a $500 deductible,” she says.

How do you apply for an ACA plan?

There are several ways to apply for an ACA plan, depending on where you live and how much help you need. You can enroll through an insurance company such as UnitedHealthcare, through a licensed insurance agent or broker, online, by phone or even by mail. Whichever option you choose, you can learn more now, or call a licensed insurance agent at 1-844-211-7730 to discuss your options.

In most cases, you can start the enrollment process while you’re on the federal Health Insurance Marketplace. As of 2024, 32 states use the website for enrollment, while 18 and the District of Columbia have created their own online marketplaces. Don’t worry if you don’t know which category your state is in. When you start the enrollment process, you’ll be directed to your state’s marketplace, if one exists.

If you need help, certified application counselors (also called assisters) are available. “They are different from agents and brokers in that, by law, they can’t have any financial interest in what they enroll you in,” Keith says. “They tend to be like community-based organizations, and they oftentimes do a lot of Medicaid enrollment and marketplace enrollment and can help families with really complex scenarios.”

The federal Health Insurance Marketplace also features a detailed checklist of information you’ll need when you enroll. Categories include information about you and your household, employer, income information and information on current health care coverage, if any.

What’s the difference between the federal Health Insurance Marketplace and a state exchange?

You can buy health insurance from the federal Health Insurance Marketplace, or if your state has its own exchange, you can buy it directly from your state’s website. Some state exchanges may also offer savings.

“States that do their own marketplaces have a lot more flexibility, and some have added state subsidies on top of federal subsidies,” says Keith.

“The state’s going to put their imprint on it, but it’s still very much dictated by the ACA and pretty federally driven,” says Keith.

Who’s eligible to enroll in Affordable Care Act plans?

In general, you’re eligible to enroll in an ACA plan if you live in the United States, are a U.S. citizen (or are lawfully present), are not in prison and don’t have Medicare coverage.

When can I apply for an Affordable Care Act plan?

The Open Enrollment Period runs from November 1 through January 15 each year. Some states vary, so be sure to check what the exact dates are where you live. Depending on when you are enrolled in a plan during the Open Enrollment Period, your coverage will start on either January 1 or February 1.

If you’re worried that you might miss the ACA deadline, don’t panic. You may still have time to sign up for benefits. If you experience certain qualifying life events, you may be eligible for a Special Enrollment Period (SEP). SEP events include:

• Losing your existing health insurance
• Moving to a different state
• Getting married
• Getting divorced
• Having a child or adopting one
• A death in the family

In most cases, you’ll need to apply within 60 days of a life event to be eligible for coverage.

A short-term health insurance plan could be an option if you’re in between health plans. Note that these plans don’t have to meet all the requirements of the ACA.

Have questions about health insurance benefits? Get more policy details now, or call a licensed insurance agent at 1-844-211-7730 to discuss your options.

How long does Affordable Care Act coverage last?

Coverage lasts until December 31 of your plan year unless you cancel your policy. In most cases, you’ll be automatically reenrolled for the following year.

“There’s a lot of inertia once you’re in, which I don’t necessarily think is a bad thing,” says Keith.

During the Open Enrollment Period, you can choose to move to a different plan. If your health or financial situation has changed, it’s worth shopping around to make sure you’re still on the best plan.

For example, if you’re receiving more care than you did before, you may find that paying a slightly higher premium will save you money in the long run. You’ll also want to check for changes in your current plan’s benefits, network and formulary.

What if my situation changes in the middle of the year?

If your income or household size changes, it’s important to update your application immediately. Depending on what has changed, you may be eligible for either more or less cost savings.

If you qualify for less savings but don’t report the change, you may have to pay money back when you file your federal income tax return.

You’ll also want to update your application if you have a new address. If you move out of state, you won’t be able to stay on the same plan. However, you’ll be eligible for an SEP, as described above.

Can I cancel my Affordable Care Act coverage in the middle of the year?

Yes, you can cancel your ACA plan at any time. For example, you might cancel if you turn 65 and qualify for Medicare or if you drop your adult child from your plan when they get job-based coverage.

What if I get employer coverage during the time I’m enrolled in an Affordable Care Act plan?

If you’re offered health insurance through your employer — even if you don’t accept it — you may lose eligibility for any savings on your ACA plan. But you can keep the coverage without the savings if you choose to do so.

Am I required to get Affordable Care Act coverage?

Based on current federal law, you’re not required to have health insurance, and there’s no longer a federal tax penalty if you don’t have health coverage. However, a handful of states do have health insurance coverage requirements and may charge penalties for not having qualifying health insurance, so be sure to check the requirements in your state.

Need a health plan for you or your family? Explore your options now, or contact a licensed insurance agent at 1-844-211-7730.

This article contains information that is compiled by UnitedHealthcare or its subsidiaries. UnitedHealthcare does not represent all the information provided are statements of fact.

Sources:

Centers for Medicare and Medicaid Services. “Health Insurance Marketplaces 2024 Open Enrollment Report.” March 27, 2024. Retrieved from https://www.cms.gov/files/document/health-insurance-exchanges-2024-open-enrollment-report-final.pdf

HealthCare.gov. “Affordable Care Act.” Retrieved from https://www.healthcare.gov/glossary/affordable-care-act/ Accessed April 3, 2024

HealthCare.gov. “Health coverage exemptions: forms and how to apply.” Retrieved from https://www.healthcare.gov/health-coverage-exemptions/exemptions-from-the-fee/ Accessed April 3, 2024

Healthcare.gov. “People with coverage through a job.” Retrieved from https://www.healthcare.gov/have-job-based-coverage/ Accessed April 3, 2024

HealthCare.gov. “Special enrollment opportunities.” Retrieved from https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/ Accessed April 3, 2024

HealthCare.gov. “When your income or household changes.” Retrieved from https://www.healthcare.gov/reporting-changes/why-report-changes/ Accessed April 3, 2024

UnitedHealthcare. “Explore UnitedHealthcare individual and family ACA Marketplace plans.” Retrieved from https://www.uhcexchange.com/health-marketplace-hub/unitedhealthcare-plan-options Accessed April 3, 2024

United Healthcare. “Short-term insurance plans.” Retrieved from https://www.uhone.com/health-insurance/short-term-health-insurance Accessed April 3, 2024

U.S. Department of Health and Human Services “In celebration of 10 Years of ACA marketplaces, the Biden-Harris Administration releases historic enrollment data.” March 22, 2024. Retrieved from https://www.hhs.gov/about/news/2024/03/22/celebration-10-years-aca-marketplaces-biden-harris-administration-releases-historic-enrollment-data.html

U.S. Department of Health and Human Services. “National uninsured rate reaches an all-time low in early 2023 after the close of the ACA Open Enrollment Period” August 3, 2023. Retrieved from https://aspe.hhs.gov/sites/default/files/documents/e06a66dfc6f62afc8bb809038dfaebe4/Uninsured-Record-Low-Q12023.pdf

Compliance code:
51051-X-0524