Quality Healthcare Coverage For Everyone

Financial Assistance

The ACA provides financial assistance to help make health insurance more affordable:

• Premium Tax Credits: Reduce your monthly premium payments if your household income is between 100% and 400% of the federal poverty level.
• Cost-Sharing Reductions: Lower your out-of-pocket costs for deductibles, copayments, and coinsurance if your household income is between 100% and 250% of the federal poverty level.

Use our Subsidy Calculator to estimate your savings.

Essential Health Benefits

All health insurance plans offered in the Marketplace must cover these 10 essential health benefits:

1. Ambulatory patient services (outpatient care)
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

These benefits ensure you receive comprehensive coverage for your healthcare needs.

Pre-existing Conditions

Under the Affordable Care Act:

• Health insurance companies cannot refuse to cover you or charge you more just because you have a pre-existing condition.
• They cannot charge women more than men.
• They cannot cancel your coverage when you get sick just because you made a mistake on your application.

Pre-existing conditions include cancer, diabetes, heart disease, pregnancy, and many other health conditions that may have prevented people from getting coverage in the past.

Bronze Plan Details

Bronze plans have the lowest monthly premiums but the highest costs when you need care.

Plan Features:

• Lower monthly premiums
• Higher deductibles and out-of-pocket costs
• Good option if you don't expect to use much healthcare services
• Covers all essential health benefits
• Typically covers about 60% of your healthcare costs

Bronze plans are a good choice if you want to protect yourself from worst-case medical scenarios, like serious illness or injury.

Silver Plan Details

Silver plans offer moderate monthly premiums and moderate costs when you need care.

Plan Features:

• Moderate monthly premiums
• Moderate deductibles and out-of-pocket costs
• Only category where you can get cost-sharing reductions if you qualify
• Covers all essential health benefits
• Typically covers about 70% of your healthcare costs

Silver plans are a good choice if you qualify for cost-sharing reductions or if you expect to use some healthcare services.

Gold Plan Details

Gold plans have higher monthly premiums but lower costs when you need care.

Plan Features:

• Higher monthly premiums
• Lower deductibles and out-of-pocket costs
• Good option if you expect to use a lot of healthcare services
• Covers all essential health benefits
• Typically covers about 80% of your healthcare costs

Gold plans are a good choice if you or your family need frequent care and are willing to pay a higher monthly premium to have more costs covered.

Special Enrollment Periods

Outside the annual Open Enrollment Period, you can enroll in or change plans only if you qualify for a Special Enrollment Period due to a qualifying life event.

Qualifying Life Events:

• Loss of health coverage
• Changes in household (marriage, birth, adoption)
• Changes in residence
• Other qualifying events (becoming a U.S. citizen, release from incarceration)

You usually have 60 days from the date of the qualifying life event to enroll in a new health insurance plan.