What essential health benefits are included in ACA plans?

All plans sold on the health care Marketplace are required to cover 10 essential health benefits. Keep in mind, these are minimum requirements. That means most Affordable Care Act (ACA) plans (like UnitedHealthcare Individual & Family Marketplace plans) may offer these and many more benefits. No matter which Marketplace plan you choose, you’re guaranteed to have the following benefits: Ambulatory patient services Emergency services Hospitalization Pregnancy, maternity and newborn care (including contraceptives and breastfeeding coverage) Mental health and substance use disorder services (including behavioral health treatment) Prescription medicine Rehabilitative/habilitative services and devices Laboratory services Pediatric services (including oral and vision care) Preventive and wellness services, and chronic disease management

Healthcare Marketplace Individual & Family Plans

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Benefits made to support your needs

Our ACA Marketplace plans offer a variety of plans with the right coverage and price point for you. Here’s a look at some of the benefits you could get with one of our Individual & Family plans.

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ACA plan coverage options
Plan name	Annual deductible	Metal levels
Essential		Bronze
Value		All metal levels
Standard		All metal levels
Advantage		Silver and Gold
Copay Focus	$0 medical deductible	All metal levels

Get coverage and benefits you can count on

Video transcript

[FEMALE SPEAKING ON SCREEN]

With an Individual & Family ACA Marketplace plan, you are covered for a variety of services at no additional cost. This includes services like annual checkups, flu shots and other routine vaccines, well child visits, diabetes screenings, and more, as recommended by your provider, or PCP. If you think you might need a specialist, be sure to check if your plan requires a referral in the UHC app or at myuhc.com/exchange.

To avoid surprise costs, find network providers and pharmacies, and use our simple cost estimator tool in the UHC app or also available on myuhc.com/exchange before you get care.

Your plan includes 24/7 virtual urgent care, starting as low as zero dollars. This means you can see a provider online, whenever you need to, from wherever you are.

You also have pharmacy benefits, starting at $10 for a one-month supply of generic medications at any of our network pharmacy locations, like Walgreens® or Walmart®. And certain medications to help you manage cardiac health, mental health, diabetes, and other conditions are available for $0 out of pocket.

If you're looking to stay active, you'll enjoy access to digital fitness classes through One Pass Select™ for zero dollars. Plus you can choose to get a discounted membership to thousands of popular gyms and even $0 grocery delivery.

Discover how this unique plan can support your health and well-being. Enroll now

What’s in our ACA Marketplace plans?

Get an overview of the coverage UnitedHealthcare Individual & Family ACA Marketplace plans provide and learn about benefits that help support your health and well-being.

Learn more about ACA Marketplace plans

Let’s cover a few basics and get answers to common questions about ACA Marketplace plans.

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

There are 2 big changes for ACA Marketplace plans for 2026:

Year-round open enrollment is ending: Regardless of your income, if you want coverage for 2026, you’ll need to enroll during open enrollment (November 1 to January 15, in most states). Outside of this time frame, you’ll have to prove you had a qualifying life event, like getting married or losing coverage from a spouse or employer plan, to sign up.

Subsidies might be changing: Changes to subsidies could impact premiums for all ACA Marketplace plan members starting January 1, 2026. Expect your out-of-pocket premium costs to go up, even if you’re already a member and keep the same plan.

You may qualify for financial subsidies (savings) from the government that help lower your premiums when you enroll in ACA Marketplace coverage. These subsidies could be tax credits or cost-sharing reductions to help pay for your health care costs. How much help you get depends on how much money you make.

Subsidies for ACA Marketplace plans may change in 2026. You will likely pay more for your premium than in previous years. You can learn more about the legislation through the American Rescue Plan Act (ARPA) and the Inflation Reduction Act (IRA). 

All plans sold on the health care Marketplace are required to cover 10 essential health benefits. Keep in mind, these are minimum requirements. That means most Affordable Care Act (ACA) plans (like UnitedHealthcare Individual & Family Marketplace plans) may offer these and many more benefits.

No matter which Marketplace plan you choose, you’re guaranteed to have the following benefits:

Ambulatory patient services
Emergency services
Hospitalization
Pregnancy, maternity and newborn care (including contraceptives and breastfeeding coverage)
Mental health and substance use disorder services (including behavioral health treatment)
Prescription medicine
Rehabilitative/habilitative services and devices
Laboratory services
Pediatric services (including oral and vision care)
Preventive and wellness services, and chronic disease management

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Get helpful tips and information to help you better understand your options.⁷

Disclaimers

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

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, MA, 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 New York, Inc.; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Ohio, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of South Carolina, Inc.; UnitedHealthcare Benefits of Texas, Inc; UnitedHealthcare of Texas, Inc.; UnitedHealthcare of Oregon, Inc. in WA; UnitedHealthcare of Wisconsin, Inc., and UnitedHealthcare Plan of the River Valley, Inc. in Iowa. Administrative services provided by United HealthCare Services, Inc. or their affiliates.

Footnotes

Preventive care services are covered as required by the Affordable Care Act (ACA).
$0 cost-share for network periodic oral evaluation 2 times per consecutive 12 months. Adult dental benefit coverage is limited to a $1,000 benefit maximum per plan year. Coverage for routine vision exam and eyewear is limited to once every 12 months. If you opt to receive vision care services or vision care materials that are not covered benefits under this plan, a participating vision care provider may charge you their normal fee for such services or materials. Coverage may not be available on all plans or in all states. For costs and complete details of coverage, contact your insurance agent or the company, as applicable.
Pay $10 or more for a 1-month supply of 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.
Walgreens discount valid until 12/31/26. Discount valid only for in-store purchases of eligible Walgreens brand health and wellness products by current members eligible for the UnitedHealthcare discount program. Discount cannot be used online. For a full list of Walgreens brand health and wellness products and exclusions, please visit www.walgreens.com/smartsavings. Not available in Washington.
Unless otherwise required, virtual care benefits are available only when services are delivered through a designated virtual network provider. Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be always available, or in all locations, or for all members. Check your benefit plan to determine if these services are available. Data rates may apply. Certain prescriptions may not be available and other restrictions may apply.
Members age 18 and over can earn up to a $250 reward on a prepaid Visa® card upon completion of eligible activities. To earn $50, complete the following activities: set up a UnitedHealthcare member account on myuhc.com/exchange, opt-in to all types of text messages, sign up for all paperless plan communications, and the subscriber of the plan signs up for Autopay of premiums on behalf of all members enrolled on the plan (not available in New Jersey). To earn $50, complete the health risk assessment available on myuhc.com/exchange (excludes members in a Copay Focus plan in partnership with Kelsey-Seybold Clinic in Texas). To earn $150, complete a primary care provider (PCP) visit. The PCP reward is earned after claim is processed and can take 6-8 weeks. Limit one reward per eligible member. Eligible members who are unable to participate in an available program may be permitted to earn the same reward by completing a reasonable alternative. Call the number on the back of your health plan ID card to learn more. If you receive access to certain reward funds with your Card, you agree to the terms and conditions available at HealthyBenefitsPlus.com/HealthPerks. Call 1-833-818-8692 for rewards balance. No Cash (except as required by law) or ATM Access. Fees and usage restrictions may apply. See cardholder terms for details. Issued by Citizens Alliance Bank, Member FDIC, pursuant to a license from Visa® U.S.A. Inc.
By providing your email address, you have agreed to receive email messages from UnitedHealthcare containing advertisements of UnitedHealthcare products. You can stop receiving emails at any time by clicking “unsubscribe” in the footer of any UnitedHealthcare email. UnitedHealthcare recommends that you provide an email address that is personal and not tied to any account that is shared or could be monitored by someone besides you. Emails may be sent to you unsecure and could be read in transmission or by anyone who has access to your account. By providing your email address, you agree to our Privacy Policy.

Enroll today in a UnitedHealthcare ACA Marketplace plan

Which county are you in? UnitedHealthcare Individual & Family ACA plans are not available in your area. But we can still help. No results found near you

See if you qualify for savings

Benefits made to support your needs

Compare ACA plan costs and coverage

Get coverage and benefits you can count on

Video transcript

What’s in our ACA Marketplace plans?

Learn more about ACA Marketplace plans

Looking for a plan?

Which county are you in? UnitedHealthcare Individual & Family ACA plans are not available in your area. But we can still help. No results found near you

Already a member?

Sign up for updates

Enroll today in a UnitedHealthcare ACA Marketplace plan

See if you qualify for savings

Benefits made to support your needs

Compare ACA plan costs and coverage

Get coverage and benefits you can count on

What’s in our ACA Marketplace plans?

Learn more about ACA Marketplace plans

What are ACA Marketplace health insurance plans?

What’s changing for ACA Marketplace plans in 2026?

How can I save money on the health insurance Marketplace?

What essential health benefits are included in ACA plans?

Looking for a plan?

Already a member?

Sign up for updates