ACA Basics
Learn how the Marketplace works.
Plain-English guides to ACA health insurance — subsidies, plan types, enrollment periods, and how to find affordable coverage. No jargon, no sales pitch.
Getting Started
What Is the ACA Marketplace?
The Health Insurance Marketplace (also called the Exchange) is where individuals and families buy health coverage. Plans are standardized, subsidies reduce costs, and all plans cover essential health benefits.
Who Qualifies?
Most people who don't have coverage through an employer, Medicare, or Medicaid can buy a Marketplace plan. There's no age limit (under 65 is typical, but not required). Legal residents and citizens qualify.
Essential Health Benefits
Every Marketplace plan must cover 10 categories: doctor visits, emergency care, hospitalization, maternity, mental health, prescriptions, rehab, lab tests, preventive care, and pediatric services (including dental and vision for children).
Costs & Subsidies
Metal Tiers Explained
Plans come in four levels: Bronze (lowest premium, highest out-of-pocket), Silver (moderate both), Gold (higher premium, lower costs), and Platinum (highest premium, lowest costs). All cover the same services — the difference is how you split costs with the insurer.
Premium Tax Credits
Most people qualify for subsidies that lower monthly premiums — often to $0-$10/month. Credits are based on household income relative to the Federal Poverty Level. You can apply the credit upfront (lower monthly bill) or claim it at tax time.
Cost-Sharing Reductions (CSR)
If your income is below 250% of the Federal Poverty Level and you pick a Silver plan, you get extra savings — lower deductibles, copays, and out-of-pocket maximums. These reductions only apply to Silver plans.
Enrollment
Open Enrollment Period
The annual window to enroll in or change Marketplace plans — typically November 1 through January 15. Coverage starts January 1 if you enroll by December 15. Dates can shift year to year.
Special Enrollment Periods
Life changes let you enroll outside Open Enrollment: losing coverage, moving, getting married, having a baby, losing Medicaid, or turning 26 (aging off a parent's plan). You typically have 60 days from the qualifying event.
Medicaid & CHIP
If your income is low enough, you may qualify for Medicaid (adults) or CHIP (children) instead of a Marketplace plan. Enrollment is year-round — no waiting for Open Enrollment. Eligibility varies by state.
Choosing a Plan
How to Compare Plans
Look at four things: monthly premium, deductible, out-of-pocket maximum, and whether your doctors and prescriptions are covered. Don't pick on premium alone — a $0 premium plan with a $9,000 deductible may cost more than a $50/month plan with a $1,000 deductible.
Network Types: HMO, PPO, EPO
HMO plans require referrals and staying in-network. PPO plans let you see any doctor but cost less in-network. EPO plans have no referrals but no out-of-network coverage. Know which type fits how you use healthcare.
Working with an Advisor
Why Use a Licensed Advisor?
A licensed advisor helps you navigate subsidies, compare plans across carriers, and enroll — at no cost to you. They're paid by the insurance company, not by you. They can also help with Medicaid screening and Special Enrollment.
Your Rights as a Consumer
You can end any conversation at any time. No advisor can enroll you without your explicit consent. You have the right to compare plans on your own at Healthcare.gov. All advisors must be licensed in your state.
Ready to see your options?
A licensed advisor can walk you through plans, check your subsidy, and help you enroll — at no cost.
Find an Advisor