Learn what the Affordable Care Act (ACA) is, what it changed for health insurance, and how to shop and enroll in an ACA health insurance plan.
Passed in 2010, the Affordable Care Act (ACA) is a federal law that made changes to health insurance in the United States to help more people get health coverage for themselves and their families.
The ACA made some important updates, including:
You can’t be denied coverage if you already have chronic health issues like diabetes, high blood pressure, cancer, or mental health conditions.
Many preventive care services from an in-network doctor, like annual physicals, vaccines, and important screenings, are covered at no additional cost.
Young adults can stay on their parents’ plans until age 26, even if they’re married, not living with their parents, or not in school.
Through Medicaid expansion in many states and marketplace subsidies, the ACA made health plans more accessible to more people.
ACA plans are required to cover 10 essential health benefits, including emergency care, maternity care, mental health services, and prescription drugs, with no annual or lifetime limits.
The Health Insurance Marketplace® was created so you can compare multiple plans in one place and choose what works best for you.
The Health Insurance Marketplace is an online shopping center for health plans and is open to U.S. citizens and legal residents. Some states have their own marketplace, while many use HealthCare.gov.
The marketplace makes it easier to find health plans offered by major insurers like Blue Cross and Blue Shield of North Carolina (Blue Cross NC). It also helps you compare plans, look at the doctors included in the network, and find a monthly price that works best for you.
ACA health insurance plans are grouped into four main metal tiers based on their premium costs and coverage. All tiers include coverage for preventive care from an in-network doctor.
Here's a quick look at the tiers and what they mean for you as you shop for an ACA plan.
Bronze plans typically pay 60% of covered medical costs on average, and you pay 40% of your medical expenses. These plans have the lowest premiums. However, they come with the highest out-of-pocket costs. Deductibles are high, so you pay more before your insurance starts to kick in.
Silver plans offer a moderate monthly premium. These plans usually pay 70% of covered medical costs on average, and you pay 30%. You will find lower deductibles and copays for office visits compared to Bronze plans.
Gold plans generally pay 80% of covered medical costs on average, and you pay 20% of your medical costs. These plans require higher monthly premiums, but they give you much lower out-of-pocket costs. Your deductibles are lower than Bronze and Silver plans.
Platinum plans carry the highest monthly premiums. You’ll typically only pay up to 10% of your medical costs, and your insurance covers the other 90%. These plans have the lowest deductibles and copays.
Outside the metal tier plans, catastrophic health plans are also available for people under 30 or those who qualify for a hardship or affordability exemption. These plans offer low monthly premiums and high deductibles and are designed to protect you in case of serious health issues.
You can buy ACA health insurance plans on the Health Insurance Marketplace or directly through insurance companies, but you can only use cost-saving subsidies if you get your plan through the marketplace.
The main time to sign up for a health plan is called Open Enrollment. It happens once a year in the fall. This is your chance to review your options, compare plans, and enroll for coverage for the next year.
If you have a major life change, like moving, getting married, having a baby, or losing other health coverage, you may qualify for a Special Enrollment Period. This special window lets you update or choose a plan outside of Open Enrollment.
Get reliable answers to your insurance questions, such as how to get prior authorization and submitting a claim.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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