CommonMisconceptionsAboutACAHealthInsurancePlans

We’re busting some of the most common myths about ACA marketplace plans—so you can skip the guessing and make confident choices.

Brynn Stadtmueller
Marketing Coordinator

Misconception #1: ACA Plans Don’t Cover Out-of-Network Care

Misconception #2: You Can’t Get a PPO Through the ACA Marketplace

Misconception #3: ACA Plans Are Only for the Uninsured or Low-Income Families

Misconception #4: ACA Health Plans Are the Same Everywhere

Misconception #5: ACA Health Plans Are Only for Individuals, Not Families

Clearing the Air

Key takeaways

ACA plans tend to focus on in-network care, however you're not out of luck for coverage if an emergency occurs.

HMOs and EPOs are the most common network types on the marketplace, but PPOs may still be available for you.

ACA plans aren't just for individuals or low-income families.

The Affordable Care Act (ACA) changed the game when it comes to health coverage. It made health insurance more accessible and affordable for millions of people. But it also inherited a ton of bad press. Somewhere along the way, ACA plans got wrapped in confusion, half-truths, and a few tall tales.

Whether you're shopping for a plan yourself or helping your team figure out their options through something like an ICHRA (hello, StretchDollar), let’s set the record straight.

Misconception 1: ACA Plans Don’t Cover Out-of-Network Care

You’ve probably heard this one before: “If it’s out-of-network, you’re out of luck.” Not quite.

The most common myth surrounding ACA health insurance is the idea that they provide zero coverage for out-of-network care. That’s just not true.

The Reality

Most ACA health plans are HMOs or EPOs. (Sorry for all of the acronyms. That’s the language of healthcare. You can delve into them here.) These plan types tend to focus on in-network providers to keep costs lower. But when it comes to emergencies—like a car accident, or a sudden health scare while traveling—ACA plans are required to cover out-of-network emergency care just like it was in-network.

That means no prior approvals. No extra charges just because the nearest ER didn’t happen to be in-network. Emergency means emergency. Full stop.

Imagine having a medical emergency while traveling out of state on vacation. Even if you’re far from home and the facility isn’t part of your insurer’s network, ACA regulations require that your care is covered as if it was in-network. Always double-check your plan’s details because every policy has varying limits and rules for non-emergency out-of-network care.

Also worth noting: Most ACA plans come with a national prescription drug network, so even if you're traveling, you’re likely still covered when it comes to picking up your meds.

Misconception 2: You Can’t Get a PPO Through the ACA Marketplace

A Preferred Provider Organization ( PPO) used to be the gold standard for flexibility—go wherever you want, no referrals needed. While less common today as new plan types have emerged (HMOs, EPOs, POS, oh my), many incorrectly believe that these plans are no longer available under the ACA. The truth is many markets have PPOs, it’s just that you have to be willing to pay the higher price tag for that extra flexibility.

The Reality

While PPOs are less common on the ACA marketplace, they do exist in certain areas. The reason you don’t see them everywhere mostly comes down to cost. PPOs give you more freedom, like visiting specialists or out-of-network providers without jumping through hoops. However, that freedom comes at a higher price, both for you and the insurance company.

Because of that, most ACA plans default to HMOs or EPOs. They keep premiums lower and still offer great coverage, especially if you’re good with staying in-network.

Ironically, even many traditional employer PPOs today don’t include meaningful out-of-network benefits anymore.

Misconception 3: ACA Plans Are Only for the Uninsured or Low-Income Families

Let’s just squash this one quickly: ACA plans aren’t just a fallback for the uninsured or low income earners.

The Reality

The ACA health insurance coverage is for everyone. That includes full-time workers, freelancers, part-timers, early retirees, and yes—even employers offering benefits through ICHRA.

One key part of the ACA is its income-based subsidies, which make insurance premiums more affordable for a variety of income levels. You don’t have to be near the poverty line to qualify.

That means a lot of middle-income households can get quality coverage at a price that fits their budget.

Misconception 4: ACA Health Plans Are the Same Everywhere

It’s also commonly believed that ACA plans are the same everywhere, offering the exact same options and coverage no matter where you live.

The Reality

ACA health insurance plans must follow federal guidelines regarding coverage, what’s available varies a lot by state.

For instance, California has a robust state marketplace with extensive choices, including occasional PPOs or discounted premiums. New York is the flip side of this, where the state-based marketplace is notoriously rough to work with and comes with some of the highest premiums.

Misconception 5: ACA Health Plans Are Only for Individuals, Not Families

Some believe ACA plans are just for individuals and can’t support families. Not even close.

The Reality

ACA plans are built for families, too. Children, or young dependents, can stay on a parent’s plan until age 26. Since subsidies are calculated based on household income, this often makes family coverage surprisingly affordable.

Clearing the Air

ACA health insurance plans have simplified access to healthcare for millions, but misconceptions can muddy the waters. The best way to choose a health plan—whether you’re an individual or a business—is by knowing what’s actually true.

Our advice—if you’re exploring plans on the marketplace, take the time to research your state’s offerings and consider your family’s specific healthcare needs.