ACA Health Insurance – Key Facts for New Clients
What It Is: The Affordable Care Act (ACA) is a U.S. law that makes health insurance more accessible and affordable for individuals and families.
Open Enrollment Period: Runs each year from November 1 to January 15 (special enrollment available for certain qualifying life events).
Special Enrollment Period (SEP): You may qualify outside of open enrollment if you experience life changes such as marriage, birth of a child, moving to a new state, or losing other coverage.
Essential Health Benefits: All ACA plans cover ten core benefits, including preventive care, prescription drugs, hospitalization, maternity and newborn care, and mental health services.
No Denial for Pre-Existing Conditions: Insurance companies cannot deny you coverage or charge more because of health conditions.
Subsidies & Financial Help: You may qualify for premium tax credits or cost-sharing reductions based on income, lowering your monthly payments and out-of-pocket costs.
Metal Tier Plans: ACA plans come in four categories — Bronze, Silver, Gold, and Platinum — each offering different premium and coverage levels.
Preventive Services at No Cost: Screenings, immunizations, and certain check-ups are included without additional cost.
Nationwide Marketplace Access: You can shop for ACA plans on Healthcare.gov or through licensed agents and brokers.
Penalty Status: As of 2019, there is no federal penalty for not having health insurance, but some states have their own requirements.