Your guide to Affordable Care Act Marketplace plan terms

If you’re shopping for an ACA Marketplace plan, it may help to have a guide to health insurance terms. From premiums to subsidies, it’s easier to shop for an ACA Marketplace plan that fits your needs when it’s easier to understand. Let’s take a look at some important things to know.

What are ACA Marketplace plans?

ACA Marketplace plans are health care coverage plans that people can buy on their own, rather than through an employer or another government-run program, like Medicare or Medicaid. You may also hear names like Exchange Plans and Individual & Family Plans. The health care Marketplace (also called the Exchange) is where ACA health care plans are sold.

Understanding ACA health insurance costs

Here are some terms you may need to know to help you better understand your coverage-related costs.

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Premium

The amount you pay for your ACA health insurance plan every month. The premium amount can vary.

UnitedHealthcare can help you estimate your premium and find out if you qualify for a $0 monthly premium,¹ like almost half of our ACA plan members.²

Deductible

The amount you pay for your covered medical services before your ACA health plan starts to kick in. 

UnitedHealthcare has a variety of plan options. With low or $0 deductibles³ to high deductible plans, we can find a plan that suits you.

Copayment

The fixed amount you’ll pay for a covered medical service at the time of getting care. The amount can vary depending on the service.

If you prefer having predictable copays, UnitedHealthcare offers Copay Focus plans³ with low copays (like $15 or $30) for most covered services, so you can plan your family's medical expenses ahead of time.

Coinsurance

The portion that you’re responsible for paying for a covered medical service.

Out-of-Pocket Max

The maximum amount you’ll have to pay during the policy period (usually a calendar year) before your health insurance starts to cover 100% of the covered amount.

Terms to know to help you save on an ACA Marketplace plan

Subsidy

The money granted by the government to offer health coverage at a reduced cost or even for no cost to low-income individuals.

UnitedHealthcare will look for subsidies that you may qualify for during the enrollment process.

Network

Includes the facilities, doctors, and providers that are contracted to provide care for you when you have ACA Marketplace health insurance coverage.

Check the provider network before enrolling in a plan or getting care so you can avoid having to pay out-of-network costs.

Formulary

Also known as a drug list, this is a list of commonly used medications organized into different cost levels called tiers. These costs are decided by a health insurer.

UnitedHealthcare Individual & Family plans offer Tier 2 (preferred generic) prescription medications for $8 or less.⁴ You can view the Prescription Drug List (PDL) to see what’s covered by an Individual & Family plan.

Explore Individual & Family ACA Marketplace plans

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Open enrollment for 2025 Individual & Family ACA Marketplace plans is November 1, 2024 through January 15, 2025. Enroll now.

Footnotes

To qualify for a $0 monthly premium, you must meet household income requirements for Advanced Premium Tax Credits (APTC).
UnitedHealthcare Internal Analysis, April 2024.
Copay Focus plans offer access to coverage with a $0 medical deductible and copays for many frequently used benefits. A deductible may apply for some prescription drug benefits. For cost shares and complete details of coverage, contact your broker or the company.
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.

Disclaimers

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.

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