Health Insurance Marketplace Guide
The Health Insurance Marketplace is where millions of Americans shop for health coverage. Whether you're self-employed, between jobs, or don't have employer insurance, the Marketplace can help you find affordable coverage.
What Is the Marketplace?
Created under the Affordable Care Act, the Marketplace is a platform to compare and purchase health insurance plans. The federal marketplace is at HealthCare.gov, though some states run their own exchanges.
When Can You Enroll?
Open Enrollment
Typically runs November 1 to January 15. Anyone can sign up or change plans during this window.
Special Enrollment Periods
Outside Open Enrollment, you can enroll after qualifying events:
- Losing existing health coverage
- Getting married or divorced
- Having or adopting a child
- Moving to a new coverage area
- Losing Medicaid eligibility
Understanding Plan Tiers
- Bronze: Plan pays ~60%. Lowest premiums, highest out-of-pocket costs. Best for healthy people wanting catastrophic protection.
- Silver: Plan pays ~70%. Moderate costs. Best value if you qualify for cost-sharing reductions.
- Gold: Plan pays ~80%. Higher premiums, lower costs when you use care.
- Platinum: Plan pays ~90%. Highest premiums, lowest out-of-pocket costs.
Financial Assistance
Premium Tax Credits
If your income is between 100% and 400% of the Federal Poverty Level, you may qualify for credits that reduce monthly premiums. Available in advance or as a tax refund.
Cost-Sharing Reductions
If your income is between 100% and 250% of FPL and you choose a Silver plan, you may get lower deductibles, copays, and out-of-pocket maximums. CSRs are only available with Silver plans.
How to Choose a Plan
- Monthly premium: What you can afford each month
- Deductible: How much you pay before insurance kicks in
- Out-of-pocket maximum: Your worst-case annual expense
- Provider network: Make sure your doctors are in-network
- Drug formulary: Check that your medications are covered
Common Mistakes
- Choosing the cheapest premium without considering total costs — a $8,000 deductible can cost more overall
- Not checking provider networks — out-of-network care costs thousands more
- Missing enrollment deadlines
- Not updating your income — keep subsidies accurate to avoid tax surprises
- Forgetting Silver plans for CSR — cost-sharing reductions only apply to Silver
The Bottom Line
Take time to compare plans, estimate your total annual costs (not just premiums), and check whether you qualify for subsidies. A little research during Open Enrollment can save you thousands throughout the year.
