The Health Insurance Marketplace was created by the Affordable Care Act (ACA) to give individuals and families one place to compare plans and get help paying for them. If you don't have affordable coverage through a job, it's often the best place to start.
This guide explains how the Marketplace works, who gets financial help, what the metal tiers mean, and when you can enroll.
How the Marketplace works
The Marketplace is a service where you fill out one application and see the plans available where you live, along with any financial help you qualify for. Some states run their own Marketplace; others use the federal one.
Who can use it
Generally, you can use the Marketplace if you live in the U.S., are a U.S. citizen or lawfully present, and aren't in prison. You can buy a plan even if you don't qualify for financial help. If you're eligible for Medicare, the Marketplace usually isn't the right place for you.
What every Marketplace plan covers
All Marketplace plans must cover a set of essential health benefits, such as doctor visits, hospital care, emergency services, prescription drugs, maternity and newborn care, mental health services and preventive care. Plans can't refuse to cover you or charge you more because of a pre-existing condition.
What changes between plans
While the core benefits are the same, plans differ in:
- monthly premium,
- deductible, copays, coinsurance and out-of-pocket maximum,
- network of doctors and hospitals (HMO, PPO, EPO and so on), and
- the drug list.
| What's the same in every plan | What differs between plans |
|---|---|
| Essential health benefits | Premium and cost-sharing |
| No denial for pre-existing conditions | Provider network |
| Free preventive care in-network | Drug list and tiers |
| Yearly out-of-pocket limit (up to a legal maximum) | Extra benefits |
Frequently asked questions
Do I qualify for a subsidy?
It depends on your expected household income, household size and whether you have access to affordable job-based coverage. The Marketplace application will tell you what you qualify for.