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

What preventive care is included in my Individual & Family plan?

All plans include a yearly wellness exam (physical) with your primary care provider. Your yearly exam is a good opportunity to check in with your doctor on how you’re feeling. It’s your chance to bring up any health concerns or questions — and get answers from your doctor. Here are common things that may happen during your yearly exam: Annual flu vaccine (and checking up to make sure you’re up to date on all your vaccines) Cholesterol screening Blood pressure screening Cancer screenings for adults (like breast, colorectal, cervical and lung) Standard lab work (you may have to pay for lab work) Access to $0 contraceptives, if you need them

What's a network and why is it important?

A plan’s network is a group of facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services. It’s important to see doctors within your plan’s network to make sure your visit is covered by your plan. (So you don’t have to pay more out-of-pocket.) To check your UnitedHealthcare provider directory online, sign in to your member account .

What's a primary care provider?

Your primary care provider (PCP) is the doctor, nurse practitioner or physician's assistant you'll see for most of your care. You can see them for things like yearly checkups, screenings, chronic conditions and everyday concerns. Plus, they can refer you to a network specialist if you need one.

Will I need referrals to see specialists?

Your welcome mailing will let you know if your plan requires a referral before you can see a network specialist. If that’s the case, your doctor will send us a referral for the specialist you want to see before you make your appointment. This extra step helps us make sure that specialist is in our network, and that your plan will help cover the cost.

Explore your ACA Marketplace plan options

UnitedHealthcare Individual & Family ACA Marketplace plans include 5 plan types — Advantage, Copay Focus, Value, Essential and Standard. Each plan type offers varying coverage levels to meet your needs and budget. Let’s take a closer look at your 2027 ACA Marketplace plan options and find a plan that’s right for you.

Types of ACA plans

Our ACA Marketplace plans offer a variety of plans with the right coverage and price point for you. Learn about each of our ACA plans and how they may be a good fit.

Advantage

Plan overview
Pay a higher monthly premium to get more benefits, perks and coverage. You’ll enjoy a lower deductible and lower copays for every doctor visit. Advantage plans are available in most markets on Silver and Gold metal levels. 

Who’s it for?
It may be a good fit if you see your doctor often. It may also be a good match if you’re transitioning from an employer-sponsored plan. Advantage plans offer more coverage and benefits, which may be like what your employer plan had.

Copay Focus

Plan overview
Get a plan that helps manage your budget and your health. Pay a moderate premium while getting predictable copays and a $0 medical deductible (which means your plan begins to pay their portion from day one). Copay Focus plans are available in all metal levels.  

Who’s it for?
It may be a good fit if you’re willing to pay higher costs up front to get more price transparency. You’ll know the cost of care before going to the doctor so you can budget better.

Value

Plan overview
Help protect your health and your budget. Choose from options that may include low copays for primary care visits, a health savings account (HSA) or extra benefits like dental and vision coverage. The Value plan is available in most markets on Silver and Gold metal levels. 

Who’s it for?
A wide range of people, including those who are eligible for subsidies (savings) and those who aren’t. It’s a good fit if you prefer to pay a lower premium and a higher deductible and cost share when you get care. You may consider a Value plan if you see your provider regularly and want something with a few more benefits covered than an Essential plan. 

Essential

Plan overview
Keep your costs as low as possible with the Essential plan. You’ll get basic coverage for preventive care and serious situations (like illness or injury) yet pay only a low monthly premium. Essential plans are available in most markets at the Bronze metal level.

Who’s it for?
It’s a good fit if you rarely see the doctor and want more affordable coverage. It’s generally our least expensive plan. However, you’ll have a higher deductible and copay when you do get care.

Standard

Plan overview
Also called easy pricing plans. Standard plans are offered in Bronze, Silver or Gold metal levels. Within each metal level, plans have the same deductibles, copays, coinsurance and out-of-pocket maximums.

Who’s it for?
It could be a good option if you want to clearly compare coverage options and benefits between different insurance companies before choosing a plan.

Ready to find the right ACA plan for you?

Shop for an ACA Marketplace plan

Learn about when and how to enroll

Shop for an ACA Marketplace plan

Learn about when and how to enroll

Benefits made to support your needs

Here’s a look at some of the benefits you could get with one of our Individual & Family plans.

$0 preventive care¹

When you get a UnitedHealthcare ACA Marketplace plan, you’ll pay $0 for preventive care that covers yearly checkups, immunizations and age-related screenings for you and your family.

Adult dental and vision

Choose a plan option marked “Dental + Vision” to get dental coverage with 2 checkups a year, and vision coverage with a $150 yearly allowance on frames.²

Prescriptions as low as $10³

Take advantage of low pricing on many generic prescriptions from any of our 55,000+ network pharmacies. A one-month supply starts at $10. Plus, save 20% on Walgreens-branded health and wellness products.⁴

$0 unlimited virtual urgent care⁵

Get $0 unlimited virtual urgent care 24/7. See a provider online whenever you need to from wherever you are and start feeling better faster.

Low-cost virtual mental health visits

Your mental health is as important as your physical health. UnitedHealthcare ACA Marketplace plans offer virtual visits with a mental health professional for a low copay per visit.⁵

$275 in rewards⁶

Earn up to $275 in rewards through our Health Perks™ program to help you focus on your health. Just complete a few health and account-related activities to get a prepaid Mastercard® reward.

Compare ACA plan costs and coverage

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

Shop for an ACA Marketplace plan

Why choose UnitedHealthcare ACA Marketplace plans?

30 years in the business

Nearly half (47%) of plan members paid a $0 monthly premium⁷

Nearly 1M network care professionals⁸

Frequently asked questions

ZIP code

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.

Footnoted disclaimers

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. Adult Dental Maximum Rollover Program eligibility is for members with a coverage effective date of October 1, or earlier, limited to adults that have been covered for at least 3 months during a year and who have had at least one dental claim during the plan year. Total maximum benefit for the following plan year will not exceed $2,000.
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.
Discount valid until 12/31/27. Some restrictions apply. Discount valid only for in-store purchases of eligible Walgreens brand products by current members eligible for the Smart savings discount program. Discount cannot be used online. Walgreens can discontinue program at its discretion. Excludes alcohol, charitable donations, dairy, prescription medication, durable medical equipment or supplies, or services submitted by the pharmacy to insurance for reimbursement or where otherwise limited by law, liquor department items, lottery tickets, magazines, money orders/transfers, newspapers, phone/prepaid/gift cards, photo orders, prescriptions, pseudoephedrine or ephedrine products, stamps, tobacco and transportation passes. Not available in Washington, New York, or Kelsey-Seybold plans in Texas.
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 $275 reward on a prepaid Mastercard® card upon completion of eligible activities. To earn $50, complete the following activities: set up a UnitedHealthcare member account on online account, 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 online account (excludes members in a Copay Focus plan in partnership with Kelsey-Seybold Clinic in Texas). To earn $10, complete assigned educational videos. To earn $15, get a flu vaccine between September 1 - December 31. 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 Mastercard® U.S.A. Inc. Once a member redeems a reward, they will have 365 days to use it before it expires. (not available in New York or Massachusetts).
UnitedHealthcare Internal Analysis, May 2026
UnitedHealthcare Internal Analysis, March 2026
The benefit described may not be offered on all plans or in all states. Some plans may require copayments, deductibles and/or coinsurance for these benefits.
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 (pdf).

Explore your ACA Marketplace plan options