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 2026 ACA Marketplace plan options and find a plan that’s right for you.

Choosing an ACA plan

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.

Plan overview

Pay a little more each month for your premium to get more benefits, perks and coverage. Enjoy a lower deductible and lower copays for every doctor visit.

Who’s it for?

It may be a good fit 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.

Available benefits

Adult dental and vision (look for plans marked “Dental + Vision”)¹
$0 virtual urgent care²
Member incentives
$0 digital fitness³
Discounted in-person gym membership³
$0 insulin⁴
10 free diabetes management services⁵

Ready to find the right ACA plan for you?

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 care⁶

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.¹

Prescriptions as low as $10⁷

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.⁸

$0 unlimited virtual urgent care²

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.²

$250 in rewards⁹

Earn $250 in rewards through our Health PerksTM program to help you focus on your health. Just complete a few health and account-related activities to get a prepaid Visa® card 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

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Why choose UnitedHealthcare ACA Marketplace plans?

Frequently asked questions

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

Footnoted disclaimers

$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.
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.
One Pass Select® is a voluntary program featuring a subscription based nationwide gym network, digital fitness and grocery delivery service. The information provided under this program is for general informational purposes only and is not intended to be nor should be construed as medical advice. Individuals should consult an appropriate health care professional before beginning any exercise program and/or to determine what may be right for them. Purchasing discounted gym and fitness studio memberships, digital fitness or grocery delivery services may have tax implications. Members should consult an appropriate tax professional to determine if they have any tax obligations with respect to the purchase of these discounted memberships or services under this program, as applicable. One Pass Select is a program offered by One Pass Solutions, Inc. Subscription costs are payable to One Pass Solutions, Inc. (not available in New York or Massachusetts).
$0 medications & supplies apply to Tier 1 products in the Prescription Drug List in all states except NY and MA, when filled with a prescription at a network pharmacy. In NY, $0 medications are listed as $0 Copay. This does not apply to plans in MA. Find the cost of your medications at myuhc.com/exchange.
Requires Type 1 or Type 2 diabetes diagnosis from a medical provider. Diabetic retinal eye exams limited to 1 exam per plan year. Includes certain lab tests specifically used to assess lipid levels, kidney function (including metabolic and urine), and glucose control (HgbA1C) in diabetics. Not available on all plans or in all states. 
Preventive care services are covered as required by the Affordable Care Act (ACA).
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.
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.
UnitedHealthcare Internal Analysis, May 2025
UnitedHealthcare Internal Analysis, July 2025
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.

Explore your ACA Marketplace plan options

Choosing an ACA plan

Ready to find the right ACA plan for you?