Affordable Care Act (ACA) plan basics
Not sure what ACA individual & family plans cover? Or which option is right for you? Our team of health plan experts have the answers.
A guide to plan levels and costs
Every ACA plan is assigned a metal tier: Platinum,* Gold, Silver or Bronze. All plans offer the same quality of care. The metal tier is based on how you and your plan split the costs.
Platinum
- Premium: Highest
- Out-of-pocket costs: Lowest
- Deductibles: Lowest
Gold
- Premium: Higher
- Out-of-pocket costs: Lower
- Deductibles: Lower
Silver
- Premium: Moderate
- Out-of-pocket costs: Moderate
- Deductible: Lower than Bronze plans
Bronze
- Premium: Lowest
- Out-of-pocket costs: Highest
- Deductible: Highest
On Marketplace or off? Let's compare.
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Off-Marketplace plan |
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What is it? |
A plan you buy outside of your state’s Health Insurance Marketplace® (or exchange), or on HealthCare.gov. |
A plan you buy outside of your state’s Health Insurance Marketplace® (or exchange), or on HealthCare.gov. |
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How do I shop? |
You can buy a plan through companies with direct enrollment sites (like us), using the help of a broker or on the Marketplace. |
You can buy a plan through companies with direct enrollment sites (like us) or direct through a broker, outside of the Marketplace. |
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Essential benefits? |
Yes. All ACA plans cover 10 essential benefits.* |
Yes. All ACA plans cover 10 essential benefits.* |
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Subsidies? |
Yes. You can apply for premium discounts or extra savings on your out-of-pocket costs. |
No. These plans don’t offer premium discounts or extra savings. But you may find more plan choices. |
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What's best for me? |
Great choice if you qualify for subsidies based on your household income. |
Great choice if you make too much money to qualify for subsidies. |
What is it? |
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On-Marketplace plan |
A plan you buy outside of your state’s Health Insurance Marketplace® (or exchange), or on HealthCare.gov. |
Off-Marketplace plan |
A plan you buy outside of your state’s Health Insurance Marketplace® (or exchange), or on HealthCare.gov. |
How do I shop? |
|
On-Marketplace plan |
You can buy a plan through companies with direct enrollment sites (like us), using the help of a broker or on the Marketplace. |
Off-Marketplace plan |
You can buy a plan through companies with direct enrollment sites (like us) or direct through a broker, outside of the Marketplace. |
Essential benefits? |
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On-Marketplace plan |
Yes. All ACA plans cover 10 essential benefits.* |
Off-Marketplace plan |
Yes. All ACA plans cover 10 essential benefits.* |
Subsidies? |
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On-Marketplace plan |
Yes. You can apply for premium discounts or extra savings on your out-of-pocket costs. |
Off-Marketplace plan |
No. These plans don’t offer premium discounts or extra savings. But you may find more plan choices. |
What's best for me? |
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On-Marketplace plan |
Great choice if you qualify for subsidies based on your household income. |
Off-Marketplace plan |
Great choice if you make too much money to qualify for subsidies. |
Insurance terms to know
What is coinsurance?
This is a percentage that you pay after you’ve met your deductible. For example, if your plan covers 80% of the cost for physical therapy, you pay 20%.
What is a copay?
This is a fixed amount that you typically pay at the time you get care. For example, you might pay $40 when you see your doctor.
What is a deductible?
This is the amount you pay before your health plan starts to pay for some or all of your costs.
What is an out-of-pocket maximum?
This is a cap on plan costs. Once you’ve paid this amount through deductibles, copays and coinsurance, your plan pays 100% of all covered costs for the rest of the plan year.
What is a referral?
This is an authorization from your doctor to see another doctor for a specific health service. It’s written on paper or sent electronically.
What is a subsidy?
This is a tax credit to lower health insurance costs. One type is a premium tax credit. This lowers the plan’s monthly cost. Another type is cost-sharing reductions. These help you pay less for out-of-pocket costs like deductibles, coinsurance and copays.
Questions? We’re here to help.
Get in touch with us
Our licensed agents can answer your questions and help you choose the right plan for your needs.
For Platinum plans
You can find select Platinum plans in California only. In another state? Check out the great features of our Gold, Silver and Bronze plans during Open Enrollment.
For essential benefits
Every ACA plan covers 10 essential benefits:
- Prescription drugs
- Pregnancy, maternity and newborn care
- Pediatric services, including oral and vision care
- Mental health and substance use disorder services
- Preventive and wellness services, and chronic disease management
- Laboratory services
- Emergency services
- Hospitalization
- Ambulatory services
- Rehabilitative and habilitative services and devices
Legal notices
Health plans are offered or underwritten or administered by Aetna Health of California Inc., Aetna Health Inc. (Florida), Aetna Health Inc. (Georgia), Aetna Life Insurance Company, Aetna Health of Utah Inc., Aetna Health Inc. (Pennsylvania), or Aetna Health Inc. (Texas) (Aetna). Aetna and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies.
Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Information is accurate as of the production date; however, it is subject to change.
The member-compensated testimonials on this website reflect enrollees' experience with Aetna CVS Health® individual & family plans.
Health benefits and health insurance plans contain exclusions and limitations.