3 Things You Need to Know

ACA basics made simple

Before you apply for Affordable Care Act (ACA) health insurance, it’s important to understand open enrollment dates, subsidy qualifications, and plan types.

In this guide, we break down the top 3 things you need to know to make a smart choice and save money on your health coverage.

Applying for ACA health insurance can feel overwhelming, but once you understand how the system works, it becomes much easier to find the right plan. Whether you’re a first-time applicant or looking to update your coverage, here are the three most important things you should know before applying.

1. Enrollment Periods Matter

ACA health insurance isn’t available year-round. You can typically apply during Open Enrollment, which runs from November 1 to January 15 each year. If you miss this window, you may have to wait until the next enrollment period unless you qualify for a Special Enrollment Period (SEP).

• Common SEP triggers include losing job-based coverage, moving to a new state, getting married, or having a baby.

• If you don’t qualify for a SEP and miss the deadline, you’ll be left without ACA coverage for the year.

2. Your Income Determines Financial Help

One of the biggest benefits of ACA health insurance is that many people qualify for premium tax credits that reduce monthly costs. Your eligibility depends on your household income and family size.

• Households between 100%–400% of the Federal Poverty Level (FPL) may qualify for subsidies.

• Lower-income households may even qualify for $0 monthly premium plans.

• Higher-income households may still find ACA coverage affordable due to capped rates compared to private insurance.

3. Plan Types: Bronze, Silver, Gold, and Platinum

ACA health insurance plans are split into metal tiers:

• Bronze – Lower premiums, higher deductibles. Best for those who rarely use medical services.

• Silver – Balanced coverage, moderate costs. Includes cost-sharing reductions if you qualify.

• Gold & Platinum – Higher premiums but lower out-of-pocket expenses. Best for people who use medical services frequently.

Pro tip: The best plan isn’t always the cheapest. Consider how often you see doctors, whether you need ongoing prescriptions, and if your providers are in-network.

👉 At Guardian Health Agency, we help clients evaluate all three areas—enrollment, subsidies, and plan tiers—so you don’t miss out on savings or coverage.