Your guide to Affordable Care Act Marketplace plan terms

If you’re shopping for an ACA Marketplace plan, it may help to have a guide to health insurance terms. From premiums to subsidies, it’s easier to shop for an ACA Marketplace plan that fits your needs when it’s easier to understand. Let’s take a look at some important things to know. 

What are ACA Marketplace plans?

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

Understanding ACA health insurance costs

Here are some terms you may need to know to help you better understand your coverage-related costs.


The amount you pay for your ACA health insurance plan every month. The premium amount can vary.

UnitedHealthcare can help you estimate your premium and find out if you qualify for a $0 monthly premium,1 like almost half of our ACA plan members.2


The amount you pay for your covered medical services before your ACA health plan starts to kick in. 

UnitedHealthcare has a variety of plan options. With low or $0 deductibles3 to high deductible plans, we can find a plan that suits you.


The fixed amount you’ll pay for a covered medical service at the time of getting care. The amount can vary depending on the service.

If you prefer having predictable copays, UnitedHealthcare offers Copay Focus plans3 with low copays (like $15 or $30) for most covered services, so you can plan your family's medical expenses ahead of time.


The portion that you’re responsible for paying for a covered medical service.

Out-of-Pocket Max

The maximum amount you’ll have to pay during the policy period (usually a calendar year) before your health insurance starts to cover 100% of the covered amount. 

Terms to know to help you save on an ACA Marketplace plan


The money granted by the government to offer health coverage at a reduced cost or even for no cost to low-income individuals.

UnitedHealthcare will look for subsidies that you may qualify for during the enrollment process.


Includes the facilities, doctors, and providers that are contracted to provide care for you when you have ACA Marketplace health insurance coverage.

Check the provider network before enrolling in a plan or getting care so you can avoid having to pay out-of-network costs.


Also known as a drug list, this is a list of commonly used medications organized into different cost levels called tiers. These costs are decided by a health insurer.

UnitedHealthcare Individual & Family plans offer Tier 2 prescription medications for $5 or less. You can view the Prescription Drug List (PDL) to see what’s covered by an Individual & Family plan.

More resources

Learn more and enroll in UnitedHealthcare Individual & Family plans.

  • Open enrollment for 2024 ACA Marketplace coverage runs nationwide from Nov. 1, 2023 to Jan. 16, 2024, for most states.  
  • Enroll by Dec. 15th for coverage starting Jan. 1, 2024 in most states.  
  • Enrollments completed between Dec. 16 and Jan. 16 will have coverage effective Feb. 1, 2024 in most states.

Explore Individual & Family ACA Marketplace plans

Ready to find your personalized Affordable Care Act Marketplace plan? Enter your ZIP code to view and enroll in a plan.