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Marketplace plans
Comprehensive benefits
- Covers 10 categories of essential health benefits, including mental health, prescription drugs & more.
- Preventive care included with no out-of-pocket costs.
Coverage for everyone
- Accepts people regardless of health history and doesn't charge higher rates because of it.
- Pre-existing conditions covered, no questions asked.
Cost help
- Includes built-in subsidies that lower premiums based on income, applied automatically.
- Extra cost help available for people who qualify.
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Frequently asked questions
The Affordable Care Act (ACA) is a health care law that governs major medical insurance in the United States. "Major medical" refers to comprehensive health plans that meet ACA rules. These plans:
- Cover 10 categories of essential health benefits, such as prescription drugs, mental health care, hospitalization & more.
- Accept people regardless of health status or history, and don't charge higher rates based on health.
- Include annual limits on your out-of-pocket spending.
Yep. All major medical ("Marketplace") health plans that meet Affordable Care Act standards cover pre-existing conditions. In fact, not only are the conditions covered, but you can't be denied a health plan or charged more for it because of your medical history.
(The only exception is that companies can charge higher premiums for tobacco use.)
Each year, there's a set signup window to buy major medical, ACA-approved health insurance. It's called Open Enrollment, and it runs from Nov. 1 – Dec. 15 in most states.
In states with their own marketplaces (the ones that don't use HealthCare.gov), open enrollment can vary.
Note: You don't have to use a federal or state marketplace to buy insurance, but the Open Enrollment period applies whether you buy from a government site or not.
Typically, you only have one chance to buy coverage for the year. But exceptions exist for life-changing situations, such as:
- Losing your job
- Marriage or divorce
- Having a baby (or adopting a child)
- Moving
Special Enrollment Periods give you a set window to change or add coverage, depending on the situation.
Subsidies, also known as advance premium tax credits, help people afford health insurance. They're based on income and applied automatically if you qualify. In some cases, subsidies can even lower the cost of health insurance down to zero.
Many people qualify for some level of financial help, so remember to use your correct income when looking at plans.
Marketplace plans have tiers based on metals:
- Bronze. Lower premiums and higher out-of-pocket costs. A bronze plan covers about 60% of your medical costs, on average.
- Silver. The most popular on the marketplace and the benchmark for calculating subsidies. Silver plans cover around 70% of your medical costs.
- Gold. More upfront cost but lower costs when you get care. Gold plans cover about 80% of your medical costs, on average.
- Platinum. High monthly price tag but much lower out-of-pocket costs. A platinum plan covers around 90% of your medical costs, on average.
Note: When we say that a plan covers "about 60% of your costs," we don't mean you'll pay a set 40% of every medical bill while the insurer picks up the rest. These percentages refer to something called "actuarial value." That just means the plan has an overall value of covering that percentage, on average, of your medical costs.
In general, the less you pay up front for the coverage (premium), the more you'll pay out of pocket when you get care (deductible + copays).
Major medical is good coverage, but it's also expensive. Other options for coverage include short term health insurance; fixed-benefit plans; and supplemental insurance, like accident, critical illness, dental and more. Health insurance isn't one-size-fits-all, and you can create a package that works for you.
It's temporary coverage for when life's in flux, like aging off a family plan at 26 or waiting for a new job-based health plan to start. Flexible, affordable, and available year round, short term health insurance offers protection against everyday and high medical costs, and coverage can start as soon as the next day.
With our help. Explore and compare local plans using this site, and reach out to an agent when you're ready to enroll. We're always happy to talk about your health needs, budget and other concerns to help you find the coverage you need for better peace of mind.