ACA individual & family plan basics
Wondering what ACA plans cover, or which plan is right for you?
Here's a simple guide to help you with the next steps.
On the Marketplace or off: What’s right for you?
On-Marketplace plan
You can choose to buy this type of plan using the help of a broker, through companies with direct enrollment sites or on the Health Insurance Marketplace® (aka “exchange”). This is where individuals and families can compare and shop for health plans. It is run by either the federal or state government depending on where you live.
Great choice if:
You qualify for premium discounts or extra savings on your out-of-pocket costs based on your household income.
Off-Marketplace plan
You can buy this type of plan directly through a broker or health insurance company outside of the official Marketplace (aka “off exchange”). These plans don’t offer premium discounts or extra savings. But you may find additional plan choices.
Great choice if:
You make too much money to qualify for financial help. (Tip: Many people think they won’t qualify, but actually do!)
A guide to plan levels and costs
Every ACA plan is assigned a metal tier: Platinum, Gold, Silver or Bronze. Metal tiers have nothing to do with the quality of care you receive. They determine how you and your plan split costs.
Platinum*
Premium: Highest
Out-of-pocket costs: Lowest
Deductible: Lowest
Gold
Premium: Higher
Out-of-pocket costs: Lower
Deductible: Lower
Silver
Premium: Moderate
Out-of-pocket costs: Moderate
Deductible: Lower than Bronze plans
Bronze
Premium: Lowest
Out-of-pocket costs: Highest
Deductible: Highest
Every ACA plan covers 10 essential benefits
- Prescription drugs
- Pregnancy, maternity and newborn care
- Pediatric services, including oral and vision care
- Mental health and substance use disorder services
- Preventive and wellness services, and chronic disease management
- Laboratory services
- Emergency services
- Hospitalization
- Ambulatory services
- Rehabilitative and habilitative services and devices
Big life change or one coming up?
Now that’s innovation
Innovation Health is transforming the health care journey. Through innovative programs, coordinated care, and convenient access, our health plans are personalized to fit our members’ needs. Discover how we are helping members achieve their health ambitions right in their community.
