The ACA, in plain words
What the Affordable Care Act is, which care it requires plans to include, and how it can work for you.
What is the ACA, and why should you care?
The Affordable Care Act is the federal law behind today's individual health insurance market. It lets people buy their own coverage without going through an employer, and it created the financial help that lowers what many of them pay.
The law sets the ground rules for individual plans: the benefits every plan must include, how insurers can set prices, and who can receive premium tax credits. Before it, buying your own coverage was often expensive or simply unavailable.
It also added protections for almost everyone. Insurers cannot turn you down because of a health condition, every plan must include a core set of essential benefits, and your health history cannot be used to raise your price.
If you work for yourself, are between jobs, work part time or want to check whether you qualify for savings, the ACA is what opens those doors. Even with coverage from work, it shapes the benefits and protections your plan provides.
What Marketplace plans include, and what they leave out
Covered
- Outpatient careDoctor visits, urgent care and services that do not need an overnight stay
- EmergenciesEmergency room care and emergency services
- Hospital careOvernight hospital stays and surgery
- Pregnancy and newbornsCare before and after birth, delivery, and breastfeeding support
- Mental health and recoveryCounseling, therapy and treatment for substance use
- MedicationsPrescription drugs, including contraception
- RehabilitationPhysical, occupational and speech therapy, plus related devices
- Lab workBlood tests, imaging and other diagnostic tests
- PreventionYearly checkups, recommended vaccines and screenings
- Children's careCare for kids, including their dental and vision needs
Not covered
- Adult dentalRoutine cleanings, exams and X-rays
- Adult visionRoutine eye exams, glasses and contacts
- Adult hearingHearing tests and hearing aids
- Complementary therapiesAcupuncture, massage and chiropractic sessions
- FitnessGym memberships, classes and personal trainers
- Nutrition programsDiet coaching and meal planning
- General wellnessSleep, stress and mindfulness programs
- FertilityFertility testing and IVF
- Long-term careNursing home and extended care services
- Cosmetic careProcedures that are not medically necessaryEvery policy is different, so read the benefits summary before you choose.
Who should look at a Marketplace plan?
Marketplace coverage is designed for people choosing insurance on their own.
It fits freelancers, the self-employed, people between jobs and part-time workers without benefits. It is also worth a look if you have lost workplace coverage and COBRA is too costly, or if your employer gives you an ICHRA allowance. Many people qualify for premium tax credits, and a plan can help you meet any state coverage requirement where one applies.
More about the ACA
Frequently asked questions
Are the ACA and Obamacare the same thing?
Yes. Obamacare is the informal name for the Affordable Care Act. Both refer to the same law and the same Marketplace plans and protections.
When can I sign up for a Marketplace plan?
During Open Enrollment, which happens once a year, usually from late fall into the new year. Exact dates depend on your state's Marketplace. It is also the time to switch plans.
Outside that window you may still have options.
A qualifying life event, such as a move, a new job, marriage or a new baby, can open a Special Enrollment Period for you.