If you do not get health insurance through work, Medicare or Medicaid, the Health Insurance Marketplace created by the Affordable Care Act (ACA) is the main place to buy individual and family coverage. Here is how it works and how to choose a plan.
Where to shop
Most states use HealthCare.gov, while others run their own exchange websites. All Marketplace plans cover essential health benefits, such as hospitalization, prescription drugs, maternity care, mental health services and preventive care, and cannot deny coverage because of pre-existing conditions.
The metal tiers
- Bronze: lowest premiums, highest costs when you need care. Good protection against worst-case scenarios.
- Silver: moderate premiums and costs. If your income qualifies, silver plans can include cost-sharing reductions that lower deductibles and copays.
- Gold: higher premiums, lower costs when you get care. Good if you use care regularly.
- Platinum: highest premiums and lowest costs at the time of care, not available in every area.
Some people may also qualify for catastrophic plans, which have very high deductibles and low premiums.
Financial help
Depending on household income and size, you may qualify for premium tax credits that lower your monthly premium. The Marketplace application calculates your eligibility. Report income changes during the year so your credit stays accurate and you avoid owing money at tax time.
When to enroll
Open Enrollment generally runs from November 1 to January 15 in states using HealthCare.gov; some state exchanges have different dates. Outside Open Enrollment, a qualifying life event such as losing coverage, moving, marriage or the birth of a child can give you a Special Enrollment Period, usually 60 days.
How to choose the right plan
- Check that your doctors, hospitals and prescriptions are covered in the plan’s network and formulary.
- Estimate your total yearly cost: premiums plus expected deductibles, copays and coinsurance.
- Compare out-of-pocket maximums, which cap your worst-case costs.
- Consider an HSA-eligible plan if you want to save pre-tax money for medical expenses.
Free, trained assistance is available through HealthCare.gov’s local help finder. Learn the basics in our health insurance guide.
This article is for general information only and is not insurance, legal or financial advice. Rules and prices vary by state and insurer. Check your policy and talk to a licensed agent before making changes.