What essential health benefits are included in ACA plans?

All plans sold on the health care Marketplace are required to cover 10 essential health benefits. Keep in mind, these are minimum requirements. That means most Affordable Care Act (ACA) plans (like UnitedHealthcare Individual & Family Marketplace plans) may offer these and many more benefits. No matter which Marketplace plan you choose, you’re guaranteed to have the following benefits: Ambulatory patient services Emergency services Hospitalization Pregnancy, maternity and newborn care (including contraceptives and breastfeeding coverage) Mental health and substance use disorder services (including behavioral health treatment) Prescription medicine Rehabilitative/habilitative services and devices Laboratory services Pediatric services (including oral and vision care) Preventive and wellness services, and chronic disease management

What preventive care is included in my Individual & Family plan?

All plans include a yearly wellness exam (physical) with your primary care provider. Your yearly exam is a good opportunity to check in with your doctor on how you’re feeling. It’s your chance to bring up any health concerns or questions — and get answers from your doctor. Here are common things that may happen during your yearly exam: Annual flu vaccine (and checking up to make sure you’re up to date on all your vaccines) Cholesterol screening Blood pressure screening Cancer screenings for adults (like breast, colorectal, cervical and lung) Standard lab work (you may have to pay for lab work) Access to $0 contraceptives, if you need them

What's a network and why is it important?

A plan’s network is a group of facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services. It’s important to see doctors within your plan’s network to make sure your visit is covered by your plan. (So you don’t have to pay more out-of-pocket.) To check your UnitedHealthcare provider directory online, sign in to your member account .

What's a primary care provider?

Your primary care provider (PCP) is the doctor, nurse practitioner or physician's assistant you'll see for most of your care. You can see them for things like yearly checkups, screenings, chronic conditions and everyday concerns. Plus, they can refer you to a network specialist if you need one.

Will I need referrals to see specialists?

Your welcome mailing will let you know if your plan requires a referral before you can see a network specialist. If that’s the case, your doctor will send us a referral for the specialist you want to see before you make your appointment. This extra step helps us make sure that specialist is in our network, and that your plan will help cover the cost.

Explore your ACA Marketplace plan options

UnitedHealthcare Individual & Family ACA Marketplace plans include four plan types — Essential, Value, Advantage and Copay Focus. Each plan type offers varying coverage levels to meet your needs and budget. Let’s take a closer look at your 2025 ACA Marketplace plan options and find a plan that’s right for you.

Choosing an ACA plan

Watch these short videos to learn about each of our ACA Marketplace plans and how they may be a good fit.

More plan types

Ready to find the right ACA plan for you?

Shop for an ACA Marketplace plan

Learn about when and how to enroll

ACA plan benefits included with most plans

Some of the benefits you could get with one of our Individual & Family plans include:

Low to $0 monthly premiums

Depending on your household income, you may qualify for low or even $0 health plans, which can help make health coverage more affordable than you might expect.

Adult dental and vision

Your vision and dental health are as important as your overall health. That's why we offer the option for you to add adult dental and vision coverage.¹ You also get the benefit of a $150 allowance that goes toward the cost of your frames.¹

Prescriptions for $8 or less²

Pay a $8² copay (or less) for Tier 2 generic prescriptions at over 45,000 network pharmacies. Plus, get member-exclusive discounts, like 20% off Walgreens branded health and wellness products.

Health Perks^TM rewards program

Earn a $150³ reward on a prepaid Visa card by completing 5 steps: visit your primary care provider, register your online account at myuhc.com, sign up for paperless communications and text messages, and set up Autopay.

One Pass Select® fitness membership

Work out whenever you want with access to thousands of on-demand digital fitness classes for $0.⁴ Plus you have the option to buy an in-person gym membership at a discounted rate.

Additional benefits, based on your plan

Some UnitedHealthcare ACA Marketplace plans may include additional benefits like prescriptions delivered to your door and health savings account (HSA) eligibility.

Compare ACA plan costs and coverage

ACA plan coverage options
Plan name	Annual deductible	Metal levels
Essential		Bronze
Value		All metal levels
Advantage		Silver and Gold
Copay Focus	$0 medical deductible	All metal levels

Shop for an ACA Marketplace plan

Why choose UnitedHealthcare ACA Marketplace plans?

With 30 years in the business, we’ve got the experience to deliver plans designed for your unique needs.

Ranked best for low out-of-pocket costs⁵

Over half of plan members paid $0 premium⁶

Rated best for customer satisfaction⁷

Frequently asked questions

Learn more about ACA plans and the health insurance Marketplace

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Disclaimers

The benefits described may not be offered on all plans or in all states. Some plans may require copayments, deductibles and/or coinsurance for these benefits. The policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, review the plan coverage documents, or call or write your insurance agent/broker or the company, whichever is applicable. By responding to this offer or communication, you agree that a representative may contact you.

UnitedHealthcare Individual & Family plans medical plan coverage offered by: UnitedHealthcare of Arizona, Inc.; Rocky Mountain Health Maintenance Organization Incorporated in CO; UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Georgia, Inc; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company in AL, IN, KS, LA, MO, NE, NJ, TN, and WY; Optimum Choice, Inc. in MD and VA; UnitedHealthcare Community Plan, Inc. in MI; UnitedHealthcare of Mississippi, Inc.; UnitedHealthcare of New Mexico, Inc.; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Ohio, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of South Carolina, Inc.; UnitedHealthcare of Texas, Inc.; UnitedHealthcare of Oregon, Inc. in WA; UnitedHealthcare of Wisconsin, Inc., and UnitedHealthcare Plan of the River Valley in Iowa. Administrative services provided by United HealthCare Services, Inc. or their affiliates.

Footnoted disclaimers

$0 cost-share for network periodic oral evaluation 2 times per consecutive 12 months. Adult dental benefit coverage is limited to a $1,000 benefit maximum per plan year. Coverage for routine vision exam and eyewear is limited to once every 12 months. If you opt to receive vision care services or vision care materials that are not covered benefits under this plan, a participating vision care provider may charge you their normal fee for such services or materials. Coverage may not be available on all plans or in all states. For costs and complete details of coverage, contact your insurance agent or the company, as applicable.
Pay $8 or less for a 1-month supply of preferred generic medications listed on the Prescription Drug List (formulary). Refer to your plan documents to determine the formulary medication tiers for your state, the tier cost shares and any deductible or out-of-pocket amounts that may be required. Only applies to in-network pharmacies. See plan documents for more information. Not available on all plans or in all states.
Members age 18 and over can earn up to a $150 reward on a prepaid Visa® card upon completion of eligible activities. To earn $50, they must complete the following activities: set up a UnitedHealthcare member account on myuhc.com/exchange, opt-in to all types of text messages, sign up for all paperless plan communications, and the subscriber of the plan signs up for Autopay of premiums on behalf of all members enrolled on the plan (not available in New Jersey and New Mexico). To earn $100, they must complete a primary care provider (PCP) visit. The PCP reward is earned after claim is processed and can take 6-8 weeks. Limit one reward per eligible member. Eligible members who are unable to participate in an available program may be permitted to earn the same reward by completing a reasonable alternative. Call the number on the back of your health plan ID card to learn more. If you receive access to certain reward funds with your Card, you agree to the terms and conditions available at HealthyBenefitsPlus.com/HealthPerks. Call 1-833-818-8692 for rewards balance. No Cash (except as required by law) or ATM Access. Fees and usage restrictions may apply. See cardholder terms for details. Issued by Citizens Alliance Bank, Member FDIC, pursuant to a license from Visa® U.S.A. Inc.
One Pass Select® is a voluntary program featuring a subscription based nationwide gym network, digital fitness and grocery delivery service. The information provided under this program is for general informational purposes only and is not intended to be nor should be construed as medical advice. Individuals should consult an appropriate health care professional before beginning any exercise program and/or to determine what may be right for them. Purchasing discounted gym and fitness studio memberships, digital fitness or grocery delivery services may have tax implications. Members should consult an appropriate tax professional to determine if they have any tax obligations with respect to the purchase of these discounted memberships or services under this program, as applicable. One Pass Select is a program offered by Optum. Subscription costs are payable to Optum.
Forbes Advisor, Best Health Insurance Companies of 2024, updated May 2024.
UnitedHealthcare Internal Analysis, April 2024.
Forbes Advisor, Best Health Insurance Plans of 2024, updated May 2024.
The benefit described may not be offered on all plans or in all states. Some plans may require copayments, deductibles and/or coinsurance for these benefits.
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Explore your ACA Marketplace plan options