Understanding ACA Marketplace Health Insurance plan options

ACA Marketplace plans provide individual and family health insurance coverage for people who don't have access to affordable coverage through an employer, Medicare, Medicaid, or another source.

Marketplace plans are offered by private insurance companies and must cover essential health benefits, including doctor visits, hospital care, preventive services, prescription drugs, emergency care, and more. Plans cannot deny coverage or charge more because of pre-existing conditions.

Key Things to Know

🏥 Comprehensive Health Coverage

Depending on the plan, coverage may include:

• Doctor and specialist visits

• Hospital and emergency care

• Preventive services

• Prescription medications

• Mental health and substance use services

• Maternity and newborn care

• Laboratory services

• Rehabilitative services

💰 Financial Assistance May Be Available

• Many individuals and families may qualify for premium tax credits that reduce their monthly insurance premium. Eligibility is based primarily on household size and estimated income for the coverage year.

• Some individuals may also qualify for cost-sharing reductions, which can lower deductibles, copayments, and coinsurance when enrolled in a qualifying Silver plan.

📊 Compare More Than the Premium

When comparing Marketplace plans, consider:

• Monthly premium

• Deductible

• Copays and coinsurance

• Maximum out-of-pocket

• Doctor and hospital networks

• Prescription drug coverage

• Specialist and referral requirements

A plan with the lowest monthly premium isn't necessarily the least expensive option when you need medical care.

Marketplace Plan Levels

Marketplace plans are generally grouped into four metal levels:

• Bronze — Generally lower premiums and higher costs when you receive care.

• Silver — Moderate premiums and costs; Silver plans are also important for people who qualify for cost-sharing reductions.

• Gold — Generally higher premiums with lower costs when receiving covered care.

• Platinum — Generally the highest premiums with the lowest costs when receiving covered care.

The metal level reflects how you and the insurance company generally share healthcare costs,it does not indicate the quality of care.

When Can You Enroll?

OPEN ENROLLMENT: November 1 – January 15

• This is the annual enrollment period for Marketplace coverage. Generally, enrolling by December 15 provides coverage beginning January 1; enrolling by January 15 generally provides coverage beginning February 1.

SPECIAL ENROLLMENT PERIODS

You may be able to enroll outside of Open Enrollment if you experience a qualifying life event, such as:

• Losing other health coverage

• Getting married

• Having or adopting a child

• Moving

• Certain changes in household circumstances

Some people may also qualify for a Special Enrollment Period based on estimated household income or other circumstances.

Need Help Comparing ACA Plans?

Choosing health insurance involves more than finding the lowest premium. We can help you compare premiums, deductibles, networks, prescriptions, out-of-pocket costs, and available savings to help you find coverage that fits your needs and budget.

Call 330-716-1368 for a no-cost, no-obligation consultation.

Marketplace plan availability, premiums, benefits, provider networks, prescription coverage, and costs vary by plan, location, household size, and income. Eligibility for financial assistance is determined through the Marketplace. We do not offer every plan available in your area.