Health Insurance Marketplace FAQ: 2027 Guide & Common Questions

What can Marketplace plans cover?

Every plan offered through the ACA Marketplace is required to cover the same 10 essential health benefit categories: ambulatory patient services, emergency services, hospitalization, pregnancy and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive and wellness services, and pediatric services including oral and vision care. Marketplace plans also cover recommended preventive services at no cost when delivered in-network, and cannot deny coverage or charge more based on pre-existing conditions, thanks to federal guaranteed issue protections.

This uniform benefit requirement is one of the most important, if under-appreciated, features of Marketplace coverage: no matter which insurer or specific plan you choose, you're guaranteed these same 10 categories of care. What varies between plans isn't whether a category is covered at all, but how much you pay for it, through your deductible, copays, and coinsurance, and which specific providers and medications fall within your plan's network and formulary.

What plan tiers are offered?

Marketplace plans fall into four metal tiers based on actuarial value, the estimated share of costs the plan covers versus what you pay: Bronze (roughly 60%), Silver (roughly 70%), Gold (roughly 80%), and Platinum (roughly 90%). Bronze plans have the lowest monthly premiums but the highest out-of-pocket costs; Platinum plans have the highest premiums but the lowest deductibles and out-of-pocket costs, since your plan starts sharing costs earlier. As covered in more detail in our guide to choosing a health insurance plan, the cheapest premium isn't always the cheapest plan overall once your realistic healthcare needs are factored in.

A fifth category, Catastrophic coverage, exists for people under 30 or those who qualify for a hardship exemption, offering very low premiums with very high deductibles designed primarily to protect against worst-case medical events rather than everyday care. Catastrophic plans are generally not eligible for premium tax credits, which is worth knowing before assuming this category offers the same subsidy benefits as the four standard metal tiers.

Marketplace vs. off-Marketplace plans

Off-Marketplace health insurance plans are sold directly by insurers or brokers rather than through Healthcare.gov or a state exchange. Both Marketplace and off-Marketplace plans require a monthly premium, and off-Marketplace plans can sometimes carry lower sticker-price premiums. The critical distinction: only Marketplace plans are eligible for premium tax credits and cost-sharing reductions, so a lower off-Marketplace premium can still end up costing more than a subsidized Marketplace plan once your actual eligibility is factored in.

Off-Marketplace plans generally still must comply with the same ACA rules around essential health benefits and pre-existing conditions if they're sold as ACA-compliant coverage, which is distinct from short-term health insurance, a separate category of plans that don't meet ACA requirements at all and typically exclude pre-existing conditions entirely. Confirming exactly which category a specific off-Marketplace plan falls into is worth doing before assuming it offers comparable protections to a Marketplace plan.

Who's eligible to enroll?

To enroll in Marketplace coverage, you generally must live in the United States, be a U.S. citizen or national or otherwise lawfully present, and not be currently incarcerated. Beyond basic eligibility, enrollment itself is generally limited to the annual open enrollment window unless you qualify for a Special Enrollment Period triggered by a qualifying life event, such as losing job-based coverage, marriage, or the birth of a child.

Other common qualifying events include moving to a new coverage area, gaining or losing a dependent, a change in income that affects subsidy eligibility, and losing coverage due to an insurer exiting your specific market. Most Special Enrollment Periods require action within 60 days of the qualifying event, so acting promptly once one of these life changes occurs matters considerably more than assuming you can enroll whenever convenient.

How can I save money — and what changed?

Depending on your expected household income, you may qualify for premium tax credits that lower your monthly bill, or cost-sharing reductions that lower your deductible and copays. Your children may also qualify for CHIP even if your household doesn't qualify for Medicaid. Here's the part that genuinely changed and needs updating from older versions of this page: the enhanced premium tax credits that removed the income cliff entirely from 2021 through 2025 expired at the end of 2025. As covered in more detail in our guide to what determines health insurance cost, the 400% federal poverty level cliff is back for 2026 and 2027, meaning households above that income level now receive zero premium tax credit rather than a reduced one, and subsidized enrollees are seeing an average premium payment increase of roughly 114%.

When does open enrollment happen?

For 2027 coverage specifically, this window runs November 1, 2026 through January 15, 2027 in most states, per confirmed Healthcare.gov guidance. After open enrollment closes, you can only enroll or change plans if you qualify for a Special Enrollment Period.

What if my insurer leaves the Marketplace?

This is a genuinely current concern worth addressing directly: several major insurers have exited or announced exits from the ACA Marketplace heading into 2027. As covered in more detail in our guides to Aetna's confirmed 2026 exit and Cigna's announced 2027 exit, if your specific carrier leaves your market, your existing plan won't be available for renewal, and you'll need to select a new carrier during open enrollment. CMS typically provides a Special Enrollment Period for people affected by an insurer's market exit, giving you additional time to enroll even outside standard deadlines. Watching for this kind of news specific to your own carrier is worth doing each year, rather than assuming your current plan will automatically remain available indefinitely.

Marketplace vs. Medicaid vs. Medicare

These three programs are frequently confused but serve different populations. The Marketplace sells private insurance plans, often with income-based subsidies, to people who don't have access to other qualifying coverage. Medicaid is a joint federal-state program providing free or nearly free coverage to those below a specific income threshold, with no enrollment deadline. Medicare is federal coverage primarily for people 65 and older or with certain disabilities, entirely separate from income. If you're unsure which applies to you, a licensed advisor can help clarify based on your specific age and income situation.

It's genuinely common for someone to qualify for more than one of these programs depending on their exact circumstances, or to fall into a coverage gap where they qualify for none of them, particularly in states that haven't expanded Medicaid. Confirming your specific eligibility for each program separately, rather than assuming one automatically excludes the others, is worth doing directly with a licensed agent if your situation isn't perfectly clear-cut.

Can self-employed people use the Marketplace?

Yes. The Marketplace is one of the most common coverage paths for self-employed individuals and small business owners without access to group coverage. If you're genuinely self-employed with net self-employment income, premiums you pay may also qualify for the self-employed health insurance tax deduction. Self-employed applicants use the same open enrollment window and Special Enrollment Period rules as anyone else applying individually.

One detail worth knowing specifically for self-employed applicants: because self-employment income can fluctuate meaningfully from month to month or year to year, projecting your annual income accurately for subsidy purposes can be genuinely more difficult than for someone with a fixed salary. Working with a licensed agent or tax professional to arrive at a realistic income estimate, rather than guessing, helps avoid an inaccurate subsidy that has to be reconciled at tax time.

Quick answers to common Marketplace questions