Affordable Care Act (ACA) plans
The Affordable Care Act (ACA) requires most health insurance plans to cover essential benefits, but the way you buy coverage—through the Marketplace or directly from insurers—determines whether you can access subsidies and what options you’ll see.

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 Affordable Care Act Health Insurance Overview

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The Affordable Care Act (ACA), often called "Obamacare," was designed to expand access to health insurance, improve quality of care, and protect consumers. All ACA-compliant plans—whether purchased through the Marketplace or off-Marketplace—must cover the 10 essential health benefits, including:

• Outpatient care

• Emergency services

• Hospitalization

• Maternity and newborn care

• Mental health and substance use treatment

• Prescription drugs

• Rehabilitative and habilitative services

• Laboratory services

• Preventive and wellness care

• Pediatric services (including dental and vision)

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Marketplace (On-Exchange) Plans

Marketplace plans are purchased through the Health Insurance Marketplace® (HealthCare.gov or state exchanges).
Key features:

• Subsidies available: You may qualify for premium tax credits and cost-sharing reductions based on income, which can significantly lower monthly premiums and out-of-pocket costs.

• ACA-compliant: All Marketplace plans cover the 10 essential benefits.

• Standardized tiers: Bronze, Silver, Gold, and Platinum levels help compare coverage and costs.

• Eligibility checks: Marketplace enrollment considers household income, family size, and whether you have other coverage (like employer insurance).

Marketplace plans are ideal if you want financial assistance or need a straightforward way to compare

standardized options.

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 Off-Marketplace (Off-Exchange) Plans

Off-Marketplace plans are purchased directly from insurance companies or brokers, outside of HealthCare.gov.
Key features:

• No subsidies: You cannot receive ACA subsidies or cost-sharing reductions.

• ACA-compliant: These plans still cover the 10 essential benefits and meet ACA standards.

• More flexibility: Insurers may offer additional plan designs, different provider networks, or unique coverage options not listed on the Marketplace.

• Best for higher earners: If your income disqualifies you from subsidies, off-Marketplace plans may sometimes offer lower premiums or more tailored coverage.

Off-Marketplace plans are often chosen by people who want specific carriers, networks, or plan designs that aren’t available on the Marketplace.

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 In summary: Both Marketplace and Off-Marketplace plans meet ACA standards, but Marketplace plans unlock subsidies and standardized comparisons, while Off-Marketplace plans may offer more flexibility but no financial assistance.

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