What is ACA?

Marketplace & Enrollment Periods: The ACA established health insurance marketplaces (or exchanges) where individuals can shop for and enroll in health insurance plans. There's an annual Open Enrollment Period (typically from November 1 to December 15 in most states) when people can enroll in a plan or change their existing plan. Special Enrollment Periods are available for those who experience qualifying life events, such as marriage, childbirth, or loss of other coverage.

Essential Health Benefits: ACA-compliant plans must cover a set of ten essential health benefits, including outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services, and pediatric services, including oral and vision care.

Pre-existing Conditions: Under the ACA, insurance companies cannot refuse coverage or charge higher premiums to individuals with pre-existing conditions. This provision ensures that more people can access health insurance regardless of their health history.

Subsidies and Tax Credits: To make health insurance more affordable, the ACA provides subsidies and tax credits for low- to moderate-income individuals and families. The Advanced Premium Tax Credit (APTC) can lower monthly premiums, and Cost-Sharing Reductions (CSR) can reduce out-of-pocket costs for eligible enrollees.


Individual Mandate: While the ACA originally required most Americans to have health insurance or face a tax penalty, the penalty for not having coverage was reduced to $0 at the federal level starting in 2019. However, some states have implemented their own individual mandates.

Medicaid Expansion: The ACA allowed states to expand Medicaid coverage to more low-income adults. As of my last update, not all states have chosen to expand Medicaid. This expansion significantly increased access to healthcare for millions of Americans. Young Adult Coverage: Under the ACA, young adults can stay on their parents' health insurance plans until they turn 26. This provision has increased insurance coverage among young adults.

Insurance Plan Categories: ACA plans are categorized into four "metal" levels — Bronze, Silver, Gold, and Platinum — that indicate the plan's cost-sharing structure. Bronze plans have the lowest monthly premiums and highest out-of-pocket costs, while Platinum plans have the highest premiums and lowest out-of-pocket costs.