ACA (Affordable Care Act) / Marketplace

Full Definition

The Patient Protection and Affordable Care Act (ACA), enacted March 2010, restructured the U.S. individual and small-group health insurance markets. It created the state and federal Marketplaces (exchanges) through which consumers purchase subsidized Qualified Health Plans, defined Essential Health Benefits, prohibited pre-existing-condition denials, and expanded Medicaid in participating states. Premium Tax Credits (APTC/PTC) subsidize premiums for households up to 400% FPL — and, under the American Rescue Plan and IRA extensions, above 400% FPL through 2025. ACA OEP runs November 1 to January 15 (federal marketplace; some state exchanges differ). ACA commissions are carrier-paid (not CMS-capped like Medicare), typically $15–$25 per member per month (PMPM) for certified agents.

Related Terms

• Open Enrollment (ACA) — The annual November 1 – January 15 window (on the federal Marketplace) during which consumers can enroll in or change ACA Qualified Health Plans.
• SEP (Special Enrollment Period) — A year-round enrollment window triggered by qualifying life events — loss of coverage, move, marriage, income change — that allows enrollment outside OEP.
• Under-65 Health Insurance — Health insurance for consumers not yet Medicare-eligible — primarily ACA marketplace plans, short-term medical, and indemnity products.
• Short-Term Medical (STLDI) — Limited-duration health insurance — often non-ACA-compliant — used as a gap-filler between jobs, missed OEP, or when consumers want lower premiums than ACA plans.
• CMS (Centers for Medicare & Medicaid Services) — The federal agency within HHS that administers Medicare, Medicaid, CHIP, and the federal ACA Marketplace — and sets binding rules for all three.

Where This Applies on InsureLeads

• Medicare Leads
• Final Expense Leads
• ACA / Health Leads
• IUL Leads