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Let's go over how coverage works.

How comfortable are you navigating Affordable Care Act (ACA) insurance ... or insurance at all?

No matter where you’re at, we’ve covered what you need to know for open enrollment on November 1. 

Is ACA coverage right for you?

If you don’t have insurance through your job or a government program like Medicare, take a look at ACA Individual and Family plans. They’re available for almost everyone. And they can help you take care of your most important asset — you.

Let’s dig into ACA coverage

What ACA plans cover

All ACA individual & family plans must cover 10 essential benefits like hospitalization, preventive care and mental health services. Some plans offer extras like dental and vision. 

ACA plan levels

Every plan is assigned what is known as a metal tier: Platinum, Gold, Silver or Bronze. Metal tiers have nothing to with the quality of care you receive. They determine how you and your plan split costs.

On or off the Marketplace

You can apply for ACA coverage and financial help through companies with direct enrollment sites or on the federal Marketplace. If you shop off the Marketplace, you won’t get financial help.

Saving money on your plan

When you enroll in a plan on the Marketplace, you may be eligible for discounts on your monthly bill or extra savings on your out-of-pocket medical costs.

The top insurance terms you'll want to know

Let's go over some common insurance terms you might see during your coverage search.

Save the date: ACA enrollment periods 

When is the Open Enrollment Period?

The time to choose an ACA individual & family plan is right around the corner. The Open Enrollment Period for 2025 opens on November 1, 2025 and ends January 15, 2026. Enroll by December 15, 2025 for coverage that starts January 1, 2026.

The Open Enrollment Period is the time of year when you can explore plan options, see if your doctor participates in the plan, apply for financial help and purchase health plan coverage.  So you don’t want to miss out.

If I miss the deadline, can I still sign up for ACA coverage? 

Life won’t wait for Open Enrollment.  So certain life events — called qualifying events — let you sign up for coverage outside the typical Open Enrollment window. 

What’s an example of a qualifying life event? 

Maybe you no longer have health care coverage because you’ve lost your job. Or maybe you’re getting married or having a baby or moving to a new state. These life events — and others — all give you the right to sign up for a health plan outside the Open Enrollment Period as long as you do so no more than 60 days after the event. 

Transforming health care, together

Banner|Aetna aims to offer access to more efficient and effective member care at a more affordable cost. We join the right medical professionals with the right technology, so members benefit from quality, personalized health care designed to help them reach their health ambitions.

Contact us

Health benefits and health insurance plans are offered, underwritten, and/or administered by Banner Health and Aetna Health Insurance Company and/or Banner Health and Aetna Health Plan Inc. (Banner|Aetna). Banner|Aetna is an affiliate of Banner Health and of Aetna Life Insurance Company and its affiliates (Aetna). Each insurer has sole financial responsibility for its own products. Aetna and Banner Health provide certain management services to Banner|Aetna. Aetna, CVS Pharmacy® and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies.

On-Demand Virtual Care with 98point6 by Transcarent

Banner|Aetna offers access to 98point6 by Transcarent, a virtual care solution that enables members to connect to care anytime, anywhere via secure in-app messaging.

Treatment is provided by a U.S.-based care team, including board-certified doctors, who can diagnose and treat over 1,000 conditions, outline care options, prescribe* medication, and order labs or imaging when appropriate—all through the convenience of a mobile app.

Key Features:

  • Audio, video, and Spanish translation support available as needed
  • Access to care plans and lab results directly within the app
  • Referrals to in-network resources and specialists
  • Care is available in all 50 states and Washington D.C.
  • 24/7/365 access with an average wait time of under 2 minutes—no appointment required.

Available to enrolled Banner|Aetna members and covered dependents age 1+* in an eligible plan.

Cost: Low-to-no-cost per visit*, depending on plan details.

*FOR ENROLLED MEMBERS AND COVERED DEPENDENTS AGE 1+: 98point6 by Transcarent is available to members age 1-17 when an adult parent or guardian is also enrolled in the plan. Access to 98point6 by Transcarent is not included in all plans.

*FOR LOW-TO-NO-COST WITH 98POINT6 BY TRANSCARENT: Members enrolled in a health savings account (HSA) or qualified high-deductible health plan (HDHP) must pay the applicable cost-share for virtual care visit until their deductible is met, after which services will be provided at no cost-share. All other health plan members pay $0 per virtual care visit regardless of whether their deductible has been met. Please refer to your plan documents for your applicable cost-share amounts.

*FOR 98POINT6 BY TRANSCARENT PRESCRIBING: 98point6 by Transcarent providers do not prescribe controlled substances (such as opioids), lifestyle medications (such as Viagra and Propecia) or weight loss medications (Wegovy or Ozempic). 98point6 by Transcarent and Transcarent Clinic clinicians are independent contractors and are neither agents nor employees of Banner|Aetna or plans administered by Banner|Aetna, and does not guarantee that a prescription will be written. Transcarent Clinic providers will not prescribe DEA-controlled substances, non-therapeutic drugs and certain other drugs that may be harmful because of their potential for abuse. Clinicians reserve the right to deny care for potential misuse of services

This material is for information only. An application must be completed to obtain coverage. Rates and benefits vary by location. Providers are independent contractors and are not agents of Banner|Aetna. Provider participation may change without notice.

Health insurance plans contain exclusions and limitations.