Health Marketplace

The Affordable Care Act established three main goals:

1. To make health insurance more affordable for millions of Americans 
2. Expand the Medicaid program
3. And support innovation in delivering medical care in a way that reduces costs

It allows individuals and small businesses to compare and enroll in a variety of insurance plans through Health Marketplaces.

• Small businesses can use the Small Business Health Options Program (SHOP) to provide health insurance for their employees.
• Includes healthcare coverage for an individual or a whole family.
• Children can remain under their parents' health insurance plan until they are 26 years old. 

All ACA plans cover 10 essential health benefits:

1. Emergency services
2. Outpatient care
3. Hospitalization including surgery and overnight stays
4. Pregnancy, maternity, and newborn services 
5. Mental health and substance use disorder services, including behavioral health treatment like counseling and psychotherapy
6. Pediatric services like oral and vision care
7. Prescription drugs
8. Rehabilitative and habilitative services and devices (to help people with injuries, disabilities, or chronic conditions to gain or recover mental and physical skills)
9. Laboratory services
10. Preventive care, wellness services, and chronic disease management

Health Marketplace plans may also include additional benefits, such as birth control coverage, breastfeeding coverage, dental coverage, vision coverage, or medical management programs. 

• Additional benefits vary depending on ACA plan. 

ACA plans have monthly premiums and out-of-pocket costs to pay for health care. Certain laws provide premium tax credits or premium subsidies to qualifying enrollees to make ACA coverage more affordable. 

Besides a monthly premium, paying out-of-pocket may be necessary when receiving care that is not considered preventive. Out-of-pocket costs may also incur if you receive preventive care from an out-of-network healthcare professional. 

Open Enrollment Starts: November 1, 2025

Open Enrollment Ends: December 15, 2025

There are special enrollment periods for people who have experienced a sudden life event like a having a baby, marriage, or job loss. Typically,  you have 60 days before or 60 days after the qualifying event to enroll in an ACA plan.