Buying an ACA policy on the healthcare exchange

There are a few things you should know to buy a policy on the ACA health insurance marketplace.

All plans on the marketplace must cover 10 essential health benefits. These benefits include maternity, prescription drug, mental health, hospitalization and outpatient coverage. The ACA also limits out-of-pocket costs. The amount may depend on the plan or your income.

The exchanges provide certain basic guarantees of coverage, but you still need to research your options before choosing a health plan.

To prepare for the process, here's what you need.

1. Find out when open enrollment is in your state

You can only sign up or make changes to your individual health plan during open enrollment. The open enrollment period in most states is between Nov. 1 and Jan. 15, or Dec. 15 if you want your coverage to start on January 1. There are a handful of states that have slightly different open enrollment periods.

You can’t sign up for or change a health plan in the exchanges outside of the open enrollment period unless you have a qualifying life event. This could be losing eligibility for other health coverage, such as your spouse losing a job. You can also qualify for a special enrollment for certain life events, including having a child, getting married or moving.

If you go through a qualifying life event, you can sign up for a plan or change an existing plan outside of open enrollment.

2. Gather the necessary documents

Before digging into the different ACA exchange plans, let’s go over what you will need in the application process.

Here’s what you should gather before looking for a plan:

  • Name, contact information, date of birth and social security number for you and every member of your household who needs coverage or is listed on your federal tax return.
  • Incarceration status for anyone for whom you’re applying.
  • Immigration status, document type and number for any member of your household who is an immigrant.
  • Job information about you and every member of your household. That includes wages and employer work information. You’ll want to fill out the Employer Coverage Tool for any household member with a job who’s getting coverage through your plan.
  • Your other household income. You’ll include child support, veterans’ payments and Supplemental Security Income (SSI).
  • A list of federal tax deductions that you claim.
  • Specifics about any health insurance coverage anyone has in your household. Include coverage type, name of person, insurance company, policy number, etc.

You can start your application process once you have all the information that you’ll need.

3. Understand the application process

While there is still an application process, the ACA forbids a health insurer from denying you or charging you much higher rates because of your health status.

Before the ACA, insurers could reject people, charge them exorbitant fees or drop them if they used health insurance too much. The ACA ended those practices. You’re now guaranteed health insurance regardless of your health.

To apply for an ACA plan , you can go online, by phone, with in-person help, through an agent or broker or with a paper application. You can call 1-800-318-2596.

If you go online, you’ll set up an account with a username, password and security questions. You can then move onto the application. You’ll choose your state and it will take you to the right place. Some states have their own marketplaces. The site will transport you there if needed.

Use the information you gathered earlier to answer all the relevant questions, such as your personal information.

4. You may be eligible for an ACA subsidized plan

Once the website has all of your information, it will tell you if you’re eligible for subsidies or credits. The ACA plans offer tax credits and lower rates for people who fall below certain income thresholds.

For instance, you qualify for tax credits if you earn up to 400% of the federal poverty level. The federal poverty level is $30,000 for a family of four in 2023. You will be informed during the application process if you qualify.

The health insurance exchange website provides cost information for each plan with your income in mind.

Health insurance finder tool

Have you become unemployed within the last 60 days and lost your health insurance?
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COBRA

The Consolidated Omnibus Reconciliation Act, better known as COBRA, allows you to stay on your former employer's health insurance plan to bridge the gap until you get new coverage. COBRA is expensive, as you will pay the full premium without help from your employer. It should be considered a short-term solution.
Learn more about COBRA
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Medicare

Most people over the age of 65 qualify for Medicare. Original Medicare includes Parts A and B, for medical and hospital care. Medicare Advantage plans, administered by private health insurers, are called Part C, and include everything in Parts A and B. Many Advantage plans also include extra benefits like vision, hearing and dental coverage. Medicare Part D, which covers prescription drugs, can be added to either option.
Medicare costs vary depending on which option you choose.
Learn more about Medicare costs.
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Medicaid

You may qualify for Medicaid based on your income. Guidelines for eligibility differ by state. To find out if you qualify in your state, contact the local Medicaid office.
You may also want to consider an ACA plan. The ACA provides subsidies for lower-income people. Learn more:
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Parent's employer-sponsored health insurance

You can stay on your parent's health insurance plan until age 26 under the Affordable Care Act. For most people, this is the cheapest option. A dependent usually costs less to insure than a spouse or an individual.
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Spouse's employer-sponsored health insurance

If your spouse can add you to their employer-sponsored plan, it will likely be more affordable than seeking coverage on your own. In most cases, coverage for a spouse is available, but not always.
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Learn more about each plan type
  • PPO
  • HMO
  • HDHP
  • EPO
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Employer-sponsored health insurance

Health insurance through your employer is generally the most affordable option since employers pay a large portion of the monthly premium. If an employer-sponsored plan is available, it's likely the best choice. You may have more than one plan option to choose from.
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Learn more about each plan type
  • PPO
  • HMO
  • HDHP
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Employer plans are often one of these types of four plans. Click on each one to find out more.
  • PPO
  • HMO
  • HDHP
  • EPO

Preferred-provider Organization (PPOs)

  • Pay higher premiums with a lower deductible
  • You have access to more providers, but pay much more for health insurance
  • You don't want to choose a primary care physician
  • You don't want to get a referral
  • You want the ability to get out-of-network care
Preferred-provider organization (PPOs) plans are the most common type of employer-based health plan. PPOs have higher premiums than HMOs and HDHPs, but those added costs offer you flexibility. A PPO allows you to get care anywhere and without primary care provider referrals. You may have to pay more to get out-of-network care, but a PPO will pick up a portion of the costs.
Find out more about the differences between plans

Health maintenance organization (HMO)

  • Pay higher premiums with a lower deductible
  • Restricted network of providers with lower premiums
  • You want to choose a primary care physician
  • You don't mind getting a referral
  • You don't care about the ability to get out-of-network care
Health maintenance organization (HMO) plans have lower premiums than PPOs. However, HMOs have more restrictions. HMOs don't allow you to get care outside of your provider network. If you get out-of-network care, you'll likely have to pay for all of it. HMOs also require you to get primary care provider referrals to see specialists.
Find out more about the differences between plans

High-deductible health plans (HDHPs)

  • Pay lower premiums with a higher deductible
High-deductible health plans (HDHPs) have become more common as employers look to reduce their health costs. HDHPs have lower premiums than PPOs and HMOs, but much higher deductibles. A deductible is what you have to pay for health care services before your health plan chips in money. Once you reach your deductible, the health plan pays a portion and you pay your share, which is called coinsurance.
Find out more about the differences between plans

Exclusive provider organization (EPO)

  • Restricted network of providers with lower premiums
  • You don't want to choose a primary care physician
  • You don't want to get a referral
  • You don't care about the ability to get out-of-network care
Exclusive provider organization (EPO) plans offer the flexibility of a PPO with the restricted network found in an HMO. EPOs don't require that members get a referral to see a specialist. In that way, it's similar to a PPO. However, an EPO requires in-network care, which is like an HMO.
Find out more about the differences between plans
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Individual insurance
You should compare individual insurance plans, including those on the health insurance exchanges created by the Affordable Care Act (ACA). ACA plans have no restrictions on pre-existing conditions and must include certain coverage basics.
Learn more about individual insurance plans
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To learn more about ACA plans, choose the option that best fits your needs
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Individual insurance
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
Know more individual insurance / ACA
These plans have lower monthly premiums and higher out-of-pocket costs
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silver shield

Silver plans provide a good balance of monthly premiums with out-of-pocket costs. Coinsurance is 70% with a silver plan, meaning you will pay 30% of the costs after your deductible is met, up to the out-of-pocket limit. Silver plans are a good choice for people who are in generally good health but don't want high out-of-pocket costs if something goes wrong.

Bronze plans are a popular choice with those who value low monthly premiums and are willing to pay more when they need care. Coinsurance is set at 60%, meaning you will pay 40% if you do need care, up to the out-of-pocket limit. Bronze plans are good for those who don't expect to need many services outside of preventative care throughout the year.

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Individual insurance
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
Know more individual insurance / ACA
These plans have higher monthly premiums with lower out-of-pocket costs
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platinum shield

ACA platinum plans have the highest monthly premiums, but the lowest out-of-pocket costs. You'll pay more monthly in return for lower deductibles, copays and coinsurance amounts. Coinsurance with platinum plans is 90%, which means you pay 10% after the deductible, up to your out-of-pocket limit. Platinum plans are good for those who anticipate a lot of medical needs throughout the year.

Gold plans cost a little less than platinum plans, and come with higher out-of-pocket costs. The coinsurance amount on a gold plan is 80%, which means you pay 20% after the deductible, up to your out-of-pocket limit. A gold plan is a good idea if you think you'll need a lot of care throughout the year, but don't want to pay platinum premiums.

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5. Review the types of ACA plans

Once you enter in the information, the health insurance exchange website tells you what plans are available. 

There are four “metal” plans in the ACA exchanges:

  • Bronze -- Insurer pays 60%; you pay 40% (these plans have the cheapest premiums, but highest out-of-pocket costs; it's also the most popular type of ACA plan)
  • Silver -- Insurer pays 70%; you pay 30% (higher premiums than Bronze, but fewer out-of-pocket costs than Bronze)
  • Gold -- Insurer pays 80%; you pay 20% (higher premiums than Silver, but lower out-of-pocket costs than Silver)
  • Platinum -- Insurer pays 90%; you pay 10% (highest premiums, but lower out-of-pocket costs than the other three plans; only 2% of ACA plan members have a Platinum plan and you may have trouble finding one in your area)

You might be tempted by a Bronze’s plans low premiums. However, if you expect to visit medical providers frequently, you’ll pay more in out-of-pocket costs than if you had a different plan. Therefore, a Gold or Platinum plan might save you money.

If you don’t expect frequent visits to medical providers, a Bronze or Silver plan might work best. 

Also, note that the less expensive plans might have limited provider and hospital networks. These narrow-network plans could mean you won’t get to see your doctor or go to the hospital of your choice. Confirm that your doctor and hospital takes the specific plan before signing up.

After you evaluate your options and decide how you’ll pay the premiums, you’ll choose a plan and sign up.

Make sure to consider your next year of potential health costs when making your decision. Once you find the plan that best fits your needs, the website will let you choose your plan and you’ll usually get coverage on the first day of the next month.

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