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The Affordable Care Act – ACA

The Patient Protection and Affordable Care Act, also known as the ACA or Obamacare, was enacted by Congress in March of 2010. The act encompasses three main goals: to provide affordable healthcare options to more people, to expand the Medicaid program, and to support innovative medical care advancements that lower the general cost of healthcare services

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To be considered ACA compliant, plans must include ten essential health benefits, including emergency services, hospitalizations, and preventative and wellness services.

Outpatient Care

or Ambulatory patient services – outpatient care is a broad category that includes services you receive without going to a hospital. For example, wellness and prevention doctors’ appointments, diagnostic services, treatments, and rehabilitation.

Hospitalization

insurance plans are required to cover hospitalization, such as overnight stays and surgeries. This does not mean that your plan will cover the entire hospital bill, however. The average hospital stay costs over $10,000 so the amount you owe will depend on your plan’s co-payment, deductible, or co-insurance.

Pregnancy, Maternity, & Newborn Care

qualified health plans must cover these categories both before and after birth. Insurance companies cannot deny coverage or charge women more.

Mental Health & Substance Abuse Services

Pre-existing mental and behavioral health conditions must be covered, including behavioral health treatment such as counseling and psychotherapy. Insurance plan copays will apply.

Prescription Drugs

Under the health care law, at least one prescription drug must be covered for each category and classification of federally approved drugs. Limitations do apply.

Rehabilitative & Habilitative Services & Devices

Health plans must cover services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills. Examples include physical therapy or wheelchairs.

Laboratory Services

qualified insurance plans must cover lab services that help a doctor diagnose an injury, illness, condition, or monitor the effectiveness of treatment.

Preventive & Wellness Services & Chronic Disease Management

this includes services such as immunizations, screenings, physicals, and counseling.

Pediatric Services

include well-child visits, immunizations, oral and vision care (adult dental and vision coverage are not essential health benefits)

Alabama

Ambetter Health
UHC ACA

Arizona

Aetna CVS Health
Ambetter Health
Cigna
Oscar Health
UHC ACA

Arkansas

Ambetter Health

California

Aetna CVS Health
Ambetter Health
Anthem ACA
Molina Healthcare
Oscar Health

Connecticut

Anthem ACA

Delaware

Aetna CVS Health

Florida

Aetna CVS Health
Ambetter Health
Cigna IFP
HealthFirst (Central FL)
Molina Healthcare
Oscar Health
UHC ACA

Georgia

Aetna CVS Health
Ambetter Health
Anthem ACA
CareSource
Cigna IFP
Oscar Health
UHC ACA

Idaho

Molina Healthcare

Illinois

Aetna CVS Health
Ambetter Health
Cigna IFP
Molina Healthcare
Oscar Health
UHC ACA

Indiana

Aetna CVS Health
Ambetter Health
CareSource
Cigna IFP

Iowa

Medica
Oscar Health

Kansas

Aetna CVS Health
Ambetter Health
Medica
Oscar Health
UHC ACA

Kentucy

Ambetter Health
Anthem ACA
CareSource
Molina Healthcare

Louisiana

Ambetter Health
Christus Health
UHC ACA

Maine

Anthem ACA

Maryland

Aetna CVS Health
UHC ACA

Michigan

Ambetter Health
Molina Healthcare
Oscar Health
Priority Health
UHC ACA

Minnesota

Medica

Mississippi

Ambetter Health
Cigna IFP
Molina Healthcare
UHC ACA

Missouri

Aetna CVS Health
Ambetter Health
Anthem ACA
Medica
Oscar Health
UHC ACA

Nebraska

Ambetter Health
Medica
Oscar Health

Nevada

Aetna CVS Health
Ambetter Health
Anthem ACA

New Hampshire

Ambetter Health
Anthem ACA

New Jersey

Aetna CVS Health
Ambetter Health
Oscar Health
UHC ACA

New Mexico

Ambetter Health
Molina Healthcare
UHC ACA

North Carolina

Aetna CVS Health
Ambetter Health
CareSource
Cigna IFP
Oscar Health
UHC ACA

North Dakota

Medica

Ohio

Aetna CVS Health
Ambetter Health
Anthem ACA
CareSource
Molina Healthcare
Oscar Health
UHC ACA

Oklahoma

Ambetter Health
Medica
Oscar Health
UHC ACA

Pennsylvania

Ambetter Health
Cigna IFP
Oscar Health

South Carolina

Ambetter Health
Cigna IFP
Molina Healthcare
UHC ACA

Tennessee

Ambetter Health
Cigna IFP
Oscar Health
UHC ACA

Texas

Aetna CVS Health
Ambetter Health
BCBS TX
Christus Health
Cigna IFP
Molina Healthcare
Oscar Health
UHC ACA

Utah

Aetna CVS Health
Cigna IFP
Molina Healthcare

Virginia

Aetna CVS Health
Anthem ACA
Cigna IFP
Oscar Health
UHC ACA

Washington

Ambetter Health
Molina Healthcare
UHC ACA

CARRIER

Aetna CVS Health


Amerihealth Caritas


Anthem ACA


Blue Cross and Blue Shield of South Carolina


Christus Health


Cigna IFP


HealthFirst


Medica


Oscar Health


Priority Health


 

Agility send out the links from carrier portals

Ambetter Health


BCBS TX


Caresource


Molina Healthcare


UHC ACA


 

 

COMMISSION

Carrier Pays agent


Agility pays agent


Agility pays agent


Carrier Pays agent


Agility pays agent


Agility pays agent


Carrier Pays agent


Crowe pays agent


Carrier Pays agent


Carrier Pays agent


 

 

COMMISSION

Agility pays agent


Carrier Pays agent


Carrier Pays agent


Agility pays agent


Carrier Pays agent


 

 

Use the map provided to find a state-specific ACA carrier.