What Is the Health Insurance Marketplace?

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What is a marketplace health plan?
Metal tier | Costs covered by plan | Deductible level |
---|---|---|
Bronze | 60%. | High. |
Silver | 70%. | Medium. |
Gold | 80%. | Low. |
Platinum | 90%. | Low. |
What do marketplace health plans cover?
- Plans must cover 10 essential health benefits: These include emergency services, hospitalization, pregnancy care, mental health services, prescription drugs, laboratory services, and preventive and wellness services, among other things. (See all essential health benefits.)
- Plans must offer birth control coverage and breastfeeding benefits.
- Plans must cover pre-existing conditions (including pregnancy).
Who can use the health insurance marketplace?
How to enroll in a marketplace plan
- Go to HealthCare.gov.
- Click “Log In.” If you don’t have an account, you’ll be prompted to create one.
- Create an account. (If your state runs its own marketplace, you’ll be sent to that page to apply.)
- Complete the application for coverage, including your personal information, information about the people in your household, and your income and expenses.
- Once you submit your application, you’ll get information on whether you qualify for premium tax credits or assistance to help pay for premiums and other costs.
- Compare plans available to you and choose one that best meets your needs.
- Pay your premium to activate coverage. You’ll pay the insurance company, not the marketplace.
Open enrollment vs. special enrollment periods
- Losing health coverage: Losing a job, graduating from college, turning 26 and aging out of a parent’s plan, etc.
- Household changes: Marriage, divorce, having or adopting a child, or a death in the family.
- Moving: To a new ZIP code, to a new county, or to or from a place where you’re going to school or living and working, etc.
- Income changes: If your income now qualifies you for a different kind of coverage.
- Citizenship changes: You become a U.S. citizen.
- Other changes: Leaving prison, starting or ending your time with AmeriCorps, becoming a member of a federally recognized tribe, etc.
Financial assistance and subsidies
- You’re a U.S. citizen or are a legal resident of the U.S.
- You file taxes as an individual or as a married couple filing jointly.
- You don’t have access to a qualified employer plan, or your employer plan isn’t affordable. (The plan must meet minimum coverage requirements, with an employee premium that’s no more than 9.02% of household income in 2025 .)
- You aren’t eligible for Medicare, Medicaid or the Children’s Health Insurance Program (CHIP).
- Your household income is at least as high as the federal poverty level.
- You’re buying a Bronze, Silver, Gold or Platinum marketplace plan. Catastrophic plans aren’t eligible for premium tax credits.
Cost-sharing reduction
- You’re eligible for a premium tax credit.
- You’re buying a Silver plan.
- Your household income falls between 100% and 250% of the federal poverty level.
State vs. federal health insurance marketplaces
Article sources
- 1. Department of Health & Human Services. Health plan categories: Bronze, Silver, Gold & Platinum. Accessed Feb 24, 2025.
- 2. Department of Health & Human Services. Catastrophic health plans. Accessed Feb 24, 2025.
- 3. Department of Health & Human. Services. Overview of SHOP: Health insurance for small businesses. Accessed Feb 24, 2025.
- 4. Department of Health & Human Services. Tips about the Health Insurance Marketplace. Accessed Feb 24, 2025.
- 5. KFF. Explaining Health Care Reform: Questions About Health Insurance Subsidies. Accessed Feb 24, 2025.
- 6. Department of Health & Human Services. The Marketplace in your state. Accessed Feb 24, 2025.