It is a program that relies on private insurance companies for coverage. There are some requirements imposed on the private companies, such as making them cover prior conditions, and as compensation they have access to a wider pool of insured people, since most are now required to have insurance, or pay a penalty. There are subsidies for the poorest people to help them pay for the new plans.

In general, if you have insurance now and your insurer is not going to quit or raise its rates excessively, you do not have to make any changes. If you have to choose new insurance, the "exchanges" are the places to go to choose which company or plan you sign up for. Some state governments have refused to set up state-controlled exchanges, so the federal government has to set up exchanges in those states.