What You Need to Know About ACA Plans
What Are ACA Plans?
ACA plans—also known as Affordable Care Act or Marketplace plans—are health insurance policies that meet the coverage standards set by the federal health care law passed in 2010. These plans are designed to provide comprehensive protection for individuals and families, no matter your health history or pre-existing conditions.
One of the key features of ACA plans is that they must cover a core set of 10 essential health benefits, which include:
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Ambulatory patient services (outpatient care without being admitted to a hospital)
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Emergency services
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Hospitalization (such as surgery and overnight stays)
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Pregnancy, maternity, and newborn care
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Mental health and substance use disorder services, including counseling and psychotherapy
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Prescription drugs
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Rehabilitative and habilitative services and devices (to help people recover or gain functional skills)
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Laboratory services
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Preventive and wellness services and chronic disease management
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Pediatric services, including dental and vision care for children
ACA plans are available in four levels—Bronze, Silver, Gold, and Platinum—which offer different cost-sharing structures to fit a variety of budgets. Many people also qualify for subsidies or tax credits to help lower their monthly premiums or out-of-pocket costs. Whether you're self-employed, between jobs, or just looking for more affordable coverage, ACA plans offer peace of mind and quality care. Connect with us to compare plans in your market, and find out if you qualify for lower premiums or out-of-pocket costs!
How Much Do ACA Plans Cost?
The cost of an ACA (Affordable Care Act) plan can vary based on several factors, including your age, location, household size, income, and the coverage level you choose—Bronze, Silver, Gold, or Platinum. While monthly premiums are one part of the cost, you'll also want to consider deductibles, copays, and out-of-pocket maximums. The good news is that many people qualify for premium tax credits or cost-sharing reductions, which can significantly lower your monthly payments and reduce what you pay when you get care. In fact, millions of Americans pay less than $10 per month for their plan after subsidies. The only way to know your exact cost is to get a personalized quote based on your specific situation—and we’re here to help you do just that.
Are ACA Plans a Good Option
for Small Businesses?
Yes—ACA plans can be a great option for small businesses looking to offer quality, affordable health insurance to their employees. Through individual ACA plans, small employers can provide access to comprehensive coverage that includes essential benefits like doctor visits, preventive care, prescriptions, and more. Offering ACA-compliant plans can help attract and retain employees and improve workplace morale. Plus, with flexible options and no minimum participation requirements, it’s easier than ever for small business owners to find a plans that fit both their team’s needs and their budget. We’re here to help you explore your options and build a benefits package that works for your business.
What Do ACA Plans Not Cover?
While ACA (Affordable Care Act) plans offer comprehensive coverage, there are some services and items they generally do not cover.
These exclusions can include but are not limited to:
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Cosmetic procedures (like plastic surgery not deemed medically necessary)
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Adult dental and vision care
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Long-term care
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Alternative therapies such as acupuncture or massage (unless medically approved and part of your plan)
Most ACA plans also do not cover hearing aids for adults or routine foot care, unless related to a medical condition like diabetes. Additionally, over-the-counter medications and weight loss treatments or surgeries are often excluded unless prescribed for a specific medical condition and approved by the plan. Since coverage can vary by provider, it’s important to carefully review your plan’s benefits and limitations. Working with trusted experts, like the advisors at Mountaineer Health and Life Insurance, can help you understand exactly what’s included and what’s not.
When Can I Enroll in an ACA Plan?
You can enroll in an ACA (Affordable Care Act) health insurance plan during the Open Enrollment Period, which typically runs from November 1 to January 15 each year in most states. During this time, anyone can sign up for a new plan, renew their current coverage, or make changes to their existing plan.
If you miss Open Enrollment, you may still qualify for a Special Enrollment Period (SEP) if you experience a qualifying life event—such as losing other health coverage, getting married or divorced, having a baby, moving to a new area, or aging off a parent’s plan at age 26. Special Enrollment Periods usually last 60 days from the date of the event. If you’re unsure whether you qualify, we can help you determine your eligibility and guide you through the enrollment process.
What If I Can't Enroll in an ACA Plan Right Now?
If you’ve missed the Open Enrollment Period and don’t qualify for a Special Enrollment Period, you don’t have to go without coverage. Short-term medical insurance can be a smart, affordable option to help bridge the gap until you’re eligible to enroll in an ACA plan.
These plans are designed to provide temporary coverage for unexpected illnesses, injuries, or emergency care—and can start as soon as the next day. While short-term plans don’t offer all the benefits of ACA coverage and may not cover pre-existing conditions, they can still provide valuable protection and peace of mind in the meantime.
If you’re in between jobs, waiting for group coverage to start, or simply missed enrollment, we can help you find a short-term policy that fits your needs and budget.
Why Should I Work with an Agent?
Navigating health insurance can be overwhelming—but you don’t have to do it alone. Working with a licensed agent to choose your ACA (Affordable Care Act) plan takes the guesswork out of the process.
An experienced agent can:
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Help you compare plans side-by-side
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Explain your benefits
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Identify available subsidies or tax credits
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Make sure your doctors, prescriptions, and preferred hospitals are all covered
You should consider working with an agent even if you already have an ACA plan. Best of all, there’s no extra cost to you—you get expert guidance and personalized support for free.
Whether you’re enrolling for the first time or reviewing your current coverage, we can save you time, money, and frustration by helping you find a plan that truly fits your health needs and budget.
COMPARE PLANS IN YOUR AREA
We offer an innovative approach on your ability to compare plan options and enroll in the coverage that best fits your needs. At Mountaineer Health and Life Insurance, we believe that you are entitled to clarity and peace of mind. You can compare different options using the links below, but always remember that we are just a phone call away if you need help!
Let Us Help at No Cost!
We’re here to walk you through the process step by step, answer your questions along the way, and help you understand all of your options in a way that actually makes sense. Our goal is to make things simple, clear, and stress-free—so you can feel confident about the choices you’re making.