5 Things to Know About the ACA

Evergreen page. Reviewed September 26, 2026.

The Affordable Care Act (ACA) became law in 2010. Parts of it have changed many times since, but the core rules for individual and family coverage still come from it. These five matter most when you're shopping.

1. Ten essential health benefits

Every ACA-compliant plan covers the same ten categories: outpatient care, emergency services, hospitalization, pregnancy and newborn care, mental health and substance use treatment, prescription drugs, rehabilitative services and devices, lab tests, preventive care, and pediatric services including dental and vision for children. Plans differ in cost sharing and networks, not in whether these are covered.

2. Guaranteed issue

You can't be turned down or charged more because of a pre-existing condition. Your premium depends on your age, your county, whether you use tobacco, and the plan you pick. Nothing else.

3. Premium tax credits, and the cliff that came back

If you buy through HealthCare.gov and your household income falls within the eligible range, a premium tax credit lowers what you pay each month. The enhanced credits passed in 2021 expired on December 31, 2025. For 2026 and 2027, households above 400% of the federal poverty level get no credit at all (KFF). If your income is near that line, how you estimate it matters, and we'll go through it with you.

4. Metal tiers

Bronze, Silver, Gold and Platinum describe how costs are split between you and the plan, on average, not the quality of care. Silver plans unlock cost-sharing reductions for lower incomes, which can make a Silver plan better than a Gold one for the same person.

5. Enrollment windows

You can enroll during Open Enrollment (November 1, 2026 to January 15, 2027 for 2027 coverage, per HealthCare.gov) or within 60 days of a qualifying life event. Starting plan year 2027, the year-round window for households under 150% of poverty ends (H.R. 1, 2025). Miss the window and you generally wait until the next one.