What you need to know about the Affordable Care Act

Learn the basics of the Affordable Care Act (ACA), how it expands access to care, when you can enroll and tips for choosing the right plan.

Page last updated on: 5/29/25

If you're exploring health coverage options, you've probably heard of the Affordable Care Act (ACA). But what exactly is it, and how does it help you and your family? Let’s break it down.

What is the Affordable Care Act?

The ACA, sometimes known as Obamacare, is a health care reform law passed in 2010. Its main goal is to make health coverage more affordable and accessible for Americans.

What are the goals of the ACA?

  1. Make health coverage more affordable
    The ACA provides financial help with premium tax credits and cost-sharing reductions to individuals and families with low-to-moderate incomes.
  2. Expand Medicaid coverage
    The law allows states to expand Medicaid to cover more low-income adults.
  3. Improve the health care system
    The ACA encourages new ways of delivering care that focus on quality over quantity, helping reduce overall health care costs.

How can the ACA help you?

Coverage for pre-existing conditions

Before the ACA, you could be denied coverage or charged higher premiums if you had a chronic condition like asthma, diabetes or cancer. Now, you can’t be denied coverage or charged more because of your health history. This protection applies to all ACA-compliant plans.

Essential health benefits

All ACA plans must cover a set of 10 essential health benefits, including:

  • Doctor visits and outpatient care
  • Emergency services
  • Prescription drugs

This ensures that your plan covers the care you need, not just the basics.

Free preventive care

With an ACA plan, many preventive services are covered at no cost to you, even before you meet your deductible. Preventive care helps catch health issues early, when they’re easier and less expensive to treat.

These services include:

  • Annual check-ups
  • Vaccinations (like flu shots and COVID-19 vaccines)
  • Screenings for blood pressure, cholesterol, and certain cancers
  • Birth control and family planning services
  • Well-child visits

Young adult coverage

If you’re under 26, you can stay on your parents’ health coverage – even if you’re:

  • Married
  • Not living at home
  • Not financially dependent
  • In school or working

This gives young adults more time to transition to their own coverage when they’re ready.

Marketplace access

The ACA created the Health Insurance Marketplace, where you can:

  • Compare plans side-by-side
  • See if you qualify for financial help
  • Choose a plan that fits your health needs and budget

The Marketplace makes it easier to shop for coverage, especially if you don’t get coverage through an employer.

Who is eligible for ACA coverage?

You may be eligible to buy health coverage through the ACA Marketplace if you meet the following criteria:

  • You are a U.S. citizen or lawfully present immigrant: Legally present immigrants include green card holders, refugees, those granted asylum and others with legal immigration status.
  • You live in the United States: You must reside in the U.S. and plan to stay during the coverage year.
  • You are not currently incarcerated: Individuals who are incarcerated (other than pending disposition of charges) are not eligible to enroll in Marketplace coverage.
  • You don’t have access to affordable coverage elsewhere: If you’re eligible for Medicare, Medicaid or affordable employer-sponsored coverage, you may not qualify for a Marketplace plan or financial help.
  • You could also be eligible for savings: While anyone eligible can purchase coverage, those with household income that falls within 100% to 400% of the federal poverty level (FPL) may qualify for financial assistance that lowers premiums and out-of-pocket costs.

When can you enroll?

There are two times when you can enroll in an ACA health plan:

1. Open Enrollment Period

The Open Enrollment Period (OEP) is the same time each year when anyone can sign up for a Marketplace plan. OEP runs from Nov. 1-Jan. 15.

  • The last day to enroll for coverage that starts Jan. 1 is Dec. 15
  • The last day to enroll for coverage that starts Feb. 1 is Jan. 15

However, you may begin shopping for health coverage on Oct. 1. This early shopping window gives you time to compare coverage options, estimate costs and find the best plan before OEP officially begins on Nov. 1. While you can’t enroll until Open Enrollment starts, browsing plans in advance helps you make a confident, informed decision when it’s time to sign up.

2. Special Enrollment Period (SEP)

You may qualify for a Special Enrollment Period if you experience certain life events, such as:

  • Losing other health coverage
  • Getting married or divorced
  • Having a baby or adopting a child
  • Moving to a new ZIP code
  • Changes in income

You can also apply for Medicaid or the Children’s Health Insurance Program (CHIP) at any time during the year.

Ready to learn more?

Understanding the ACA and how health coverage works can feel overwhelming, but knowing and understanding the terminology makes it easier. Our Learning Center is a great resource with helpful articles, including six terms to better understand ACA plans and five financial health plan terms you should know.

Need help choosing a plan?

Priority Health offers a range of Individual and Family Plans that meet ACA standards. Whether you're new to the Marketplace or renewing your coverage, we’re here to help you find the right plan for your health and your budget. Get a free quote or take our plan quiz to help determine which plan may be right for you.