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
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)
ACA Marketplace Calculator
Financial help for Health Insurance coverage through Marketplaces.
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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
BCBS of South Carolina
Christus Health
Cigna IFP
HealthFirst
Medica
Oscar Health
Priority Health
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Ambetter Health
BCBS TX
CareSource
Molina Healthcare
UHC ACA
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COMMISSION
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Pinnacle pays agent
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COMMISSION
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COMMISSION SCHEDULE
COMMISSION SCHEDULE
Use the map provided to find a state-specific ACA carrier.