Tax Guide

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Health Insurance Marketplaces

Before the Affordable Care Act, many people were insured through either group plans (like from an employer) or individual coverage through the individual marketplace. Those ways of getting covered are still available, but the ACA added another option, a government-run marketplace.

Every state has a marketplace. There are state-run marketplaces for states that chose to expand Medicaid, and for states that did not, the federal government provides the state marketplace. The federal Marketplace is also referred to as the Exchange.

The main purpose of the government-run Exchange is to ensure that everyone has access to affordable insurance.

First and foremost: Anyone can shop and buy insurance through the applicable marketplace, regardless of income. But if you’re looking for help paying for insurance, you must buy your insurance through the government marketplace.

Let’s take a closer look at the health insurance marketplaces and the types of plans available.

What Does a Health Insurance Marketplace Provide?

Besides being a hub for shopping for and buying insurance, marketplaces can help you find subsidies and other ways to help you pay for insurance. If you’re eligible, the marketplace will help you find coverage through Medicaid, Children’s Health Insurance Program (CHIP), and other health benefit programs.

How do I find my marketplace? Start at Healthcare.gov, or call 800-318-2596 (TTY 855-889-4325). From there you can find your individual state’s marketplace. (If your state doesn’t have its own marketplace, you'll just keep using the federal marketplace.) The phones are staffed 24/7 and the information online is available in more than 150 languages. You can enroll online or by mail.

When can I enroll on the marketplaces? You can only sign up during open enrollment. But: In certain special circumstances, such as you’ve gotten married or divorced, had kids, or lost a job, you can still apply. See also Getting Help Paying for Health Insurance. (For 2017, open enrollment is November 1, 2016 through January 31, 2017.)

Who can help me understand the health insurance options? Specially trained Navigators can help you find coverage. They're there to help educate you about the plans available, but they can’t tell you which plan to pick. The advice is free, so if anyone asks you to pay for helping you select insurance, it's probably a scam.

Plans Available on the Health Insurance Marketplaces

There are four levels of plans available through the marketplaces. The differences are based on how much out-of-pocket costs you have to pay, not on the coverage itself. Those levels are:

  • Bronze – Pays 60% of covered costs. This is the minimum level required for insurance coverage.
  • Silver – Pays 70% of covered costs. This level used when figuring costs when you apply for subsidies.
  • Gold – Pays 80% of covered costs.
  • Platinum – Pays 90% of covered costs.

If you are worried about under- or overpaying for premiums, make sure you report any major life change, like:

  • Getting married or having children
  • Moving to a new state
  • Losing a job
  • Having a decrease in income of more than 20%

Catastrophic Plans

If you’re younger than 30 or exempted by financial hardship from carrying the minimum health insurance coverage, you’re eligible for a catastrophic plan. This coverage offers essential health benefits but with high deductibles. Other people can purchase a catastrophic plan, but it will not meet the requirement for minimum coverage.

Purchasing Health Insurance Through Brokers

If you’re buying your own insurance, without any subsidy, you can opt to buy your insurance through a third-party broker. Note that not all the plans available on the marketplaces are available through brokers. If they are, the coverage and price must be the same as on the health insurance marketplaces.