ACA (Affordable Care Act) Plans
These are insurance plans offered by private companies that comply with the ACA for minimum essential coverage and pre-existing conditions. All ACA Plans must provide coverage for the ten essential health benefits, which include:
• Preventive Services
• Emergency Services
• Hospitalization
• Ambulance Services
• Maternity/Newborn Care
• Mental Health Services
• Lab Tests
• Prescriptions
• Pediatric Services
• Rehabilitative Services
Marketplace Plans
You can use the health insurance marketplace to find good health coverage based on your needs. This marketplace is also commonly called a health insurance exchange, and exchanges were actually set up by ACA.
These marketplace plans can include:
- Health Maintenance Organization Plans (HMO) – These plans will limit their members to get care and treatment from specific providers within their network. They don’t usually provide coverage when you get care outside of their networks, unless it is an emergency situation. You may also have to live within the plan’s service area in order to enroll.
- Preferred Provider Organization Plans (PPO) – PPOs will let you visit any doctor, hospital, or provider to get the care and treatment you need. However, you have the option to use one of their in-network providers if you want to pay less out-of-pocket.
- Point of Service Plans (POS) – POS Plans will let you use their in-network providers to receive care and treatment, resulting in less out-of-pocket costs. However, if you need to see a specialist for any reason, you will first need a referral from your primary care doctor.
- Exclusive Provider Organization Plans (EPO) – With these plans, your services will only be covered if you use your plan’s in-network providers. This is similar to how HMO Plans operate.