Learn about the Affordable Care Act and find out how to apply through the Health Insurance Marketplace at HealthCare.gov.
Note: In response to the coronavirus pandemic, you may be eligible to apply for coverage through the Health Insurance Marketplace during the special enrollment period, February 15 - May 15, 2021.
What Is the Affordable Care Act?
The Affordable Care Act (ACA) provides individuals and families greater access to affordable health insurance options including medical, dental, vision, and other types of health insurance that may not otherwise be available. Under the ACA:
You may be able to purchase health care coverage through a state or federal marketplace that offers a choice of plans.
Insurers can't refuse coverage based on gender or a pre-existing condition.
There are no lifetime or annual limits on coverage.
Young adults can stay on their family’s insurance plan until age 26.
Seniors who hit the Medicare Prescription Drug Plan coverage gap or "donut hole" can get a discount on medications.
Read the full text of the ACA and learn more about its provisions and relationship to patients, insurers, businesses, and families.
When to Enroll
Open enrollment time typically happens at the end of the year. It’s when you can freely make changes to your health care coverage purchased through the ACA's Health Insurance Marketplace.
During the open enrollment period, you will be able to:
Re-enroll in your current plan
Choose a plan for the first time
Choose a new plan to replace your current plan
Make changes to your existing insurance plan
Typically, changes can only be made year round when:
Getting married or divorced
Having a baby or adding a dependent to your family
Losing other coverage
Moving to a new state
Qualifying for Medicaid or CHIP
Check to see if your life event qualifies you to change your coverage under a Special Enrollment Period.
How to Enroll and Get Answers to Your Questions
You can learn more about and apply for ACA health care coverage in several ways.
Find the answers to common ACA questions about submitting documents, getting and changing coverage, your total costs for health care, tax options, and more.
Using Your Coverage
If you have questions about specific parts of your insurance plan, you must contact your insurance company to get answers. Only your insurance company can answer specific questions about doctors, medications, treatments, medical equipment, and what is and is not covered under your plan.
Find contact information for your insurance company on your insurance card or bill.
If you can't find out how to contact your insurance company, contact the Marketplace Call Center.
If you need help appealing a dispute with your insurance company, contact the Marketplace Call Center.
Small Businesses
Businesses with 50 employees or fewer can offer Small Business Health Options Program (SHOP) plans to employees, starting any month of the year. Learn about small business tax credits to help companies with the equivalent of fewer than 25 full-time employees provide insurance coverage to their workers.
Health insurance helps you pay for medical services and sometimes prescription drugs. You and your insurer each agree to pay a certain dollar amount or percentage of your medical expenses.
How to Get Health Coverage
You can get health care coverage through:
Types of Health Insurance Plans
When purchasing health insurance, your choices typically fall into one of three categories:
- Traditional fee-for-service health insurance plans are usually the most expensive choice. They offer the most flexibility in choosing health care providers.
- Health maintenance organizations (HMOs) offer lower co-payments and cover the costs of more preventive care. Your choice of health care providers is limited to those who are part of the plan.
- Preferred provider organizations (PPOs) offer lower co-payments like HMOs but give you more options when selecting a provider.
Choosing a Health Insurance Plan
Reading the fine print is important when choosing health care plans. These questions may help:
- Can I go to any doctor, hospital, clinic, or pharmacy I choose?
- Are specialists, such as eye doctors and dentists covered?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
- Does the plan cover home care or nursing home care?
- Will the plan cover all medications my physician may prescribe?
- What are the deductibles? This is the amount you must pay each year before your insurance company will begin paying claims.
- Are there any co-payments? This is the amount of money you pay each time you receive medical services or a prescription.
- If there is a dispute about a bill or service, how is it handled?
Find useful information on long-term care services. Get answers to common questions and learn how to complain about long-term care.
Learn About Long-Term Care (LTC)
Long-term care (LTC) is a variety of services that include medical and non-medical care for people who have chronic illnesses or disabilities.
If you are thinking about long-term care needs for yourself or your loved one, these resources can help:
Long-Term Care Insurance
Most health insurance plans and Medicare severely limit or exclude long-term care. If you want coverage, you may need a separate long-term care insurance policy. These questions can help you evaluate long-term care insurance policies.
What health condition qualifies you for benefits?
You must be unable to independently perform some basic daily living tasks. These may include eating, walking, getting from the bed to a chair, dressing, bathing, or using a toilet.
What type of care is covered?
Does the policy cover nursing home care? Will it cover assisted living facilities that provide less care than a nursing home? If you want to stay in your home, will it pay for visiting nurses and therapists? What about help with food preparation and housecleaning?
What is the dollar limit on benefits?
Most plans provide a specific dollar benefit per day. The benefit for home care is usually about half the nursing home benefit. But some policies pay the same for both forms of care. Other plans pay only for your actual expenses.
What is the benefits period?
You can get a policy with lifetime benefits but this will cost more. Other options for coverage are from one to six years. The average nursing home stay is about 2.5 years.
Is the benefit adjusted for inflation?
If you buy a policy before age 60, the fixed daily benefit may not be enough by the time you need it.
Do benefits begin right away?
A 20 to 100 day waiting period is not unusual.
Complaints about Long-Term Care
If you feel you are in danger, call 911 or contact your local authorities.
To complain about a long-term-care facility, contact your state's long-term care ombudsman or local elder abuse resources.
Health Insurance and Health Resources for People with Disabilities
Find information about health insurance and resources for people with disabilities.
Health Coverage for People With Disabilities
If you have a disability, you have three options for health coverage through the government.
Health Resources for People With Disabilities
Federal, state, and local government agencies and programs can help with your health needs if you have a disability.
Visit USA.gov’s Government Benefits page to learn more about government programs and services that can help you and your family.
Do you have a question?
Ask a real person any government-related question for free. They'll get you the answer or let you know where to find it.
Last Updated: October 21, 2022
