01Plans
Metal tiers and network types
Bronze, Silver, Gold, and Platinum describe how you and the plan split covered costs. HMO, PPO, EPO, and POS describe which doctors you can use. Both matter, for different reasons.
Marketplace coverage
ACA coverage, in plain language.
What every marketplace plan has to cover, how the metal tiers differ, and whether a premium tax credit could lower what you pay each month.
Open Enrollment: November 1 to January 15Those are the dates in most states. Several states run their own marketplace with a later deadline. Outside the window you need a qualifying life event, and Medicaid and CHIP accept applications all year.
Start here
Four pages, and the marketplace stops being confusing.
Most of the confusion comes from two separate systems being described at once: what a plan covers, and what you pay for it.
02Savings
Premium tax credits and cost-sharing reductions
Marketplace savings come in two forms: a credit that lowers your monthly premium, and Silver-only reductions that lower your deductible and copays if your income qualifies.
03Dates
Open Enrollment and Special Enrollment
Open Enrollment runs November 1 through January 15 in most states. Outside that window you need a qualifying life event, and you generally have 60 days to use it.
04Sign up
What enrolling actually involves
Household, income, plan choice, and a first premium payment. Knowing what is asked before you start is most of what makes it quick.
What you are guaranteed
Every marketplace plan starts from the same floor.
Insurers compete on price, networks, and drug lists, but they cannot compete by covering less than the law requires or by turning away people who need care. That is the part of the marketplace worth understanding before you compare anything else.
- No plan can refuse you, charge you more, or exclude treatment because of a pre-existing condition.
- Every plan covers the 10 essential health benefits, from hospitalization and prescription drugs to maternity and mental health care.
- Preventive services from an in-network provider are covered with no cost sharing, even before you meet your deductible.
- There is no annual or lifetime dollar limit on essential health benefits.
- Every plan has an out-of-pocket maximum, so there is a ceiling on what a covered in-network year can cost you.
- Premiums can vary only by age, location, family size, tobacco use, and the plan you pick, never by gender or health history.
Dates that matter
The marketplace calendar.
- Open Enrollment begins in most states
- Nov 1
- usual deadline for coverage starting January 1
- Dec 15
- Open Enrollment ends in most states
- Jan 15
- to enroll after a qualifying life event
- 60 days
Good to know
Common questions about marketplace coverage.
What is an ACA marketplace plan?
It is individual or family health insurance that follows the rules of the Affordable Care Act. You buy it yourself rather than through an employer, it covers the 10 essential health benefits, and it cannot turn you down for a health condition. Marketplace plans are the only place you can use a premium tax credit.
Who is a marketplace plan for?
People who do not have coverage through a job, are self-employed or between jobs, are retiring before 65, work part time, or have coverage offered at work that is not affordable by the federal standard. If you are eligible for Medicare or affordable job-based coverage, the marketplace is usually not the right fit.
How much does a marketplace plan cost?
That depends on your age, your county, the plan you pick, and whether you qualify for a premium tax credit. Prices are set by insurers and filed with regulators, so the same plan costs the same wherever you buy it. Entering your ZIP code is the only way to see real numbers for your situation.
What if my income changes during the year?
Report it to the marketplace when it happens. Your premium tax credit is based on the income you estimate for the year, and it is reconciled on your federal tax return. Updating your estimate mid-year keeps the credit closer to what you actually qualify for and avoids a surprise at tax time.
Can I get coverage if I do not qualify for savings?
Yes. Anyone can buy a marketplace plan during Open Enrollment regardless of income. The protections, essential health benefits, and out-of-pocket maximum apply to every marketplace plan whether or not a tax credit is involved.
Your area
See the marketplace plans sold where you live.
Enter your ZIP code to compare plans and any savings you qualify for. No cost, and no obligation to enroll.