Health Insurance Marketplace

Marketplace plans are categorized into four levels based on the percentage of health costs they cover:

• Bronze: Covers about 60% of health care costs (lowest premiums, highest out-of-pocket costs)
• Silver: Covers about 70% of health care costs (moderate premiums and out-of-pocket costs)
• Gold: Covers about 80% of health care costs (higher premiums, lower out-of-pocket costs)
• Platinum: Covers about 90% of health care costs (highest premiums, lowest out-of-pocket costs)

Yes. Many people qualify for premium tax credits and subsidies based on their household income and family size. These credits reduce your monthly premiums, and cost-sharing reductions can lower out-of-pocket costs like copayments and deductibles for those who qualify.

Today, subsidies are generally available to people with household incomes between 100% and 400% of the Federal Poverty Level (FPL). In some cases, people with incomes above this range may qualify for help depending on local costs and family size. However, unless extended by Congress, the enhanced subsidies (expanded eligibility and higher subsidy amounts) are set to expire on December 31, 2025. Please contact an Exchange/Marketplace independent broker (listed above) or visit healthcare.gov for more information.

If your household income, family size or employment situation changes, you should report this to the Marketplace as soon as possible. You can update your application online or by calling the Marketplace, which can affect your eligibility for tax credits or coverage options.

It depends on the plan you choose. You’ll need to check if your doctor is in the plan’s network. Plans often charge more for out-of-network doctors or may not cover them at all.

If you don’t have health insurance coverage, you may have to pay for all your medical costs out-of-pocket. However, the individual mandate (which required people to have insurance or pay a penalty) no longer applies at the federal level as of 2019, though some states still have their own mandates.

You can change plans during the Open Enrollment Period or if you qualify for a Special Enrollment Period. Outside of these periods, changes to plans are generally not allowed.

If you enroll during the Open Enrollment Period by December 15, your coverage typically starts on January 1 of the next year. If you enroll between December 16 and January 15, your coverage typically starts on February 1.

Yes, you can cancel your Marketplace plan at any time, but you may be without coverage if you don't have another plan in place.

All Marketplace plans must cover a set of essential health benefits, including:

• Doctor visits
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health services
• Prescription drugs
• Preventive and wellness services
• Pediatric services (including dental and vision)