ACA Health Insurance Made Simple • SmartChoiceHealth
Guides & Basics

ACA Health Insurance Made Simple

Understand how Marketplace plans work, when to enroll, and how to qualify for savings like premium tax credits and cost-sharing reductions.

See ACA Health Plans Talk to a licensed agent
  • ✔ Free, no-obligation help
  • ✔ Licensed agents
  • ✔ Plans from top carriers
  • ✔ Secure & private

ACA at a Glance

What it is

  • Individual & family health coverage sold through the federal or state Marketplace, and directly from insurers.
  • All ACA plans cover essential health benefits and pre-existing conditions.
  • Financial help may be available based on household size and income.

Key choices you’ll make

  • Where to buy: On-Marketplace (eligible for subsidies) or Off-Marketplace (direct).
  • Plan type: HMO, EPO, PPO, or POS.
  • Metal tier: Bronze, Silver, Gold, or Platinum.

General information only—plan availability, networks, and savings vary by state, carrier and your household details. We’ll confirm what applies to you.

Common Plan Types

HMO / EPO

  • Lower premiums; in-network care only (EPO typically covers emergencies out-of-area).
  • Primary care coordination; referrals often required (HMO).

PPO / POS

  • More flexibility; out-of-network benefits with higher costs (PPO usually broader).
  • Referrals less common; premiums usually higher.

Metal Tiers (What they typically cover)

Bronze (~60%)

  • Lowest premium, highest deductibles/out-of-pocket.
  • Good for “catastrophic-style” protection.

Silver (~70%)

  • Eligible for Cost-Sharing Reductions (CSR) if income qualifies—lower deductibles/copays.
  • Balanced premium vs. costs.

Gold (~80%)

  • Higher premium, lower out-of-pocket.
  • Better if you use care more often.

Platinum (~90%)

  • Highest premium, lowest out-of-pocket.
  • Limited availability in many areas.

On-Marketplace vs. Off-Marketplace

TopicOn-Marketplace (ACA)Off-Marketplace (Direct)
Financial help Eligible for advance premium tax credits (APTC) and possibly CSR (Silver plans) if income qualifies. No APTC/CSR; you pay the full premium.
Plan choices Varies by county; standardized metal tiers. Sometimes more (or fewer) options; benefits must still meet ACA rules.
Networks Often HMO/EPO with local networks; depends on carrier. May include PPO options in some areas.
Enrollment During Open Enrollment or SEP with a qualifying life event. Generally same windows; some carriers allow limited off-cycle changes.
Prescriptions All ACA plans include prescription coverage via a formulary; tiers/pharmacies vary. Same ACA rules apply; check formulary tiers and preferred pharmacies.
If you qualify for savings, buying through the Marketplace usually reduces your monthly premium—and CSR can significantly lower deductibles on Silver plans.

Get your free, no-obligation ACA plan review

See ACA Plans Talk to an Agent

When to Enroll

PeriodWhenWhat you can do
Open Enrollment (OE) Typically Nov 1 – Jan 15 (varies by state) Apply for new coverage or change plans for the new plan year.
Special Enrollment (SEP) Year-round with a qualifying life event Enroll or change plans within your SEP window (e.g., loss of coverage, move, marriage, birth).
Medicaid / CHIP Year-round Apply anytime if income/household qualifies; coverage may start quickly.
AI/AN Enrollees Year-round American Indian/Alaska Native members can make monthly changes on-Exchange.
Off-Marketplace exceptions Varies by carrier Some carriers allow limited off-cycle changes; details vary.
Effective dates Generally the 1st of the next month Based on selection date and qualifying event timing.

Open Enrollment dates and SEP rules vary by state—we’ll confirm your best window and help you avoid any gaps in coverage.

Understanding Costs & Savings

Your Costs

  • Monthly premium (may be lowered by APTC).
  • Deductible, copays/coinsurance, and out-of-pocket maximum.
  • Drug costs depend on plan formulary and tiers.

Savings Programs

  • APTC: Lowers your monthly premium based on income & household size.
  • CSR: Lowers deductibles/copays on Silver plans if you qualify.
  • Medicaid/CHIP may offer little to no cost, if eligible.

Frequently Asked Questions

Do I qualify for a subsidy?

Most households qualify for some APTC if they buy on the Marketplace and estimate their annual income within the program limits. We’ll help you check eligibility and estimate your savings.

Will my doctor be in-network?

Networks vary by carrier and plan type. We’ll search plans that include your preferred doctors and hospitals whenever possible.

Can I change plans outside Open Enrollment?

Yes, if you have a qualifying life event (e.g., loss of coverage, move, marriage, birth). You generally have a limited window to enroll or switch.

Questions? We’re here to help.

Call, email, or book a time that works for you.
Call (407) 554-5223 [email protected]
See Plans Call (407) 554-5223

SmartChoiceHealth is a privately owned website and is not affiliated with or endorsed by the U.S. government, Medicare, or any state Marketplace. We do not offer every plan available in your area. Information provided is limited to the plans we do offer. For a full list of Medicare options, visit Medicare.gov or call 1-800-MEDICARE. For a full list of Marketplace plans, visit HealthCare.gov or your state Marketplace.

Copyright 2025 . All rights reserved

Privacy Policy  |  Terms & Conditions

ACA Health Insurance Made Simple • SmartChoiceHealth
Guides & Basics

ACA Health Insurance Made Simple

See Marketplace plans (Bronze, Silver, Gold), check subsidy eligibility, and understand networks and costs. We’ll help you compare options and enroll.

See ACA Plans Talk to a licensed agent
  • ✔ Free, no-obligation help
  • ✔ Licensed agents
  • ✔ Plans from top carriers
  • ✔ Secure & private

ACA at a Glance

What it is

  • Health insurance for individuals & families via the Marketplace (HealthCare.gov or your state exchange).
  • All plans cover the 10 essential health benefits and pre-existing conditions.
  • Financial help may lower your monthly premium and out-of-pocket costs.

Key choices you’ll make

  • Metal tier: Bronze (lower premium), Silver (CSR eligible), Gold/Platinum (higher premium, lower costs).
  • Network type: HMO/EPO vs PPO; check doctors and hospitals.
  • Total cost: Premium, deductible, copays/coinsurance, and max out-of-pocket.

Details vary by state, county and carrier—we’ll confirm what applies to you.

Common Plan Types

Metal Tiers

  • Bronze: Lowest premiums; higher deductibles/out-of-pocket.
  • Silver: Eligible for Cost-Sharing Reductions (if you qualify); balanced costs.
  • Gold/Platinum: Higher premiums; lower costs when you get care.

Networks

  • HMO/EPO: In-network only (except emergencies); usually referrals needed for HMO.
  • PPO: In- and out-of-network coverage; typically higher premiums.
  • Always verify your doctors and prescriptions.

What Marketplace Plans Include

Essential Health Benefits

  • Doctor & hospital care, maternity, mental health, Rx drugs, labs, rehab, pediatric services and more.

Preventive Care

  • Many preventive services covered at $0 in-network (e.g., annual wellness, vaccines, screenings).

Premium Tax Credits (APTC)

  • Advance credits can lower your monthly premium based on income and household size.

Cost-Sharing Reductions (CSR)

  • If eligible, choose a Silver plan to reduce deductible, copays and max out-of-pocket.

HMO / EPO vs. PPO

TopicHMO / EPOPPO
Out-of-network No coverage except emergencies. Covered, but higher cost-share.
Referrals HMO often requires PCP referral; EPO usually does not. Typically not required.
Premiums Usually lower. Usually higher.
Flexibility Stay in network for best value. More provider choice, especially when traveling.
Best for Lower premiums and you’re fine staying in network. Wider access to doctors and hospitals.
We’ll compare options side-by-side, check your doctors and meds, and explain trade-offs so you can choose confidently.

Get your free, no-obligation ACA plan review

See ACA Plans Talk to an Agent

When to Enroll

PeriodWhenWhat you can do
Open Enrollment Typically Nov 1 – Jan 15 (state dates vary) Shop and enroll in Marketplace plans for the new year.
Special Enrollment (SEP) Year-round with a qualifying life event Enroll or change plans after events like loss of coverage, move, marriage, birth, etc.
Medicaid / CHIP Any time Apply year-round; eligibility based on income and household.
Income Change Any time Update your application to adjust premium tax credits.
American Indian / Alaska Native Year-round May change plans once per month (Marketplace rules apply).
Catastrophic Plans Open Enrollment or SEP if eligible Available to under-30s or those with a hardship/affordability exemption.

Exact dates and rules depend on your state exchange; we’ll confirm your window and options.

Understanding Costs & Savings

Your Costs

  • Premium, deductible, copays/coinsurance, and a yearly out-of-pocket maximum.
  • Drug costs depend on the plan formulary and tiers.
  • Costs differ by metal tier and network type.

Savings

  • APTC: Lowers your monthly premium.
  • CSR (Silver only): Lowers deductible and copays if you qualify.
  • Medicaid/CHIP may be available based on income.

Frequently Asked Questions

How do subsidies work?

Premium tax credits (APTC) are based on your household income and size. They can be applied in advance to lower your monthly premium.

Do I have to use a Silver plan?

No—but if you qualify for cost-sharing reductions, you’ll only get those lower deductibles/copays on a Silver plan.

Will my prescriptions be covered?

Each plan has a drug formulary with tiers. We’ll check your medications and preferred pharmacies when comparing plans.

Questions? We’re here to help.

Call, email, or book a time that works for you.
Call (407) 554-5223 [email protected]
See ACA Plans Call (407) 554-5223

SmartChoiceHealth is a privately owned website and is not affiliated with or endorsed by the U.S. government, Medicare, or any state Marketplace. We do not offer every plan available in your area. Information provided is limited to the plans we do offer. For a full list of Marketplace plans, visit HealthCare.gov or your state Marketplace.

Copyright 2025. All rights reserved

Privacy Policy  |  Terms & Conditions