You're here: Home > Understanding the ACA > Changes to What You Buy

Changes to What You Buy

Want to know more about the health reform law and what it means for people without employer-based health insurance? We’ll walk you through the basics of how Affordable Care Act (ACA) has changed the health insurance buying process, all in three steps:

  1. Changes to WHAT you buy
  2. Changes to HOW you buy
  3. Changes to WHEN you buy

No More Pre-Existing Conditions

The ACA eliminated pre-existing conditions starting 2014. No more pre-existing conditions means you can’t be denied coverage, charged more, or denied treatment based on health status.

Preventive Care At No Out-Of-Pocket Cost

At least 15 free preventive services and one wellness visit are covered on major medical plans sold after 2014 without any out-of-pocket cost, regardless of whether you have met your deductible yet. Services must be done in-network to avoid cost sharing.

10 standard essential benefits

  • Laboratory Services
  • Pediatric Services
  • Emergency Services
  • Rehabilitative Services & Devices
  • Mental Health Services and Addiction Treatment
  • Preventive Services, Wellness Services, and Chronic Disease Management
  • Prescription Drugs
  • Ambulatory Patient Services
  • Maternity & Newborn Care
  • Hospitalization

Levels of Coverage

In 2014 a new metallic rating system was introduced to make it easier to tell what level of coverage you’re buying. All metallic plans must cover at least 60% of total average estimated costs for the plan’s benefit package. Meaning, 60% of covered medical expenses paid by the insurance company; 40% by the consumer.

  • Platinum = 90% MOST COVERAGE
  • Gold = 80%
  • Silver = 70%
  • Bronze = 60%
  • Catastrophic < 60% LEAST COVERAGE

Catastrophic plans are only for people under the age of 30 and they may cover less than 60% of the total average estimated costs for the plan’s benefit package. 

Plans that fill gaps in coverage

  • Supplemental Plans
    • Life Insurance
    • Dental Insurance
    • Vision Insurance
    • Critical Illness Insurance
    • Accident Insurance
  • Gap (Short-Term) Plans: Outside of an enrollment period, people may have to wait to get coverage. Gap insurance products like short-term medical insurance may be helpful if you need limited coverage outside of the enrollment window.


Get there fast

Major Medical
Short-Term Medical

By clicking “Get Quotes Now” or “Compare Rates Now” above, I consent to be contacted by representatives or agents of Augeo Affinity Insurance Services, Inc. or its affiliate/partner companies (even if I’m on a state or national do not call registry) at the e-mail, mobile phone and/or landline information I submitted, to provide me a quote or to obtain additional information needed to provide me a quote and to follow up with respect to a quote thereafter. The company may contact me through the use of an automated dialer or by use of a prerecorded message.