Frequently Asked Questions About

Marketplace Health Insurance

What can Marketplace Health Insurance plans cover?

All plans offered in the Marketplace cover these 10 essential health benefits:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization such as surgery and overnight stays.
  • Pregnancy, maternity, and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services including devices to help people with injuries, disabilities, or chronic conditions.
  • Laboratory services
  • Preventive and wellness services and chronic disease management.
  • Pediatric services, including oral and vision care

Marketplace plans also cover free preventive health services at no cost to you when delivered by a doctor or provider in your plan’s network and offers coverage for pre-existing conditions.

What health plans are offered through the Health Insurance Marketplace?

There are four categories of health insurance plans: Bronze, Silver, Gold, and Platinum. Each type of plan has different levels of coverage and costs. The type of plan that is right for you depends on your needs and budget.

  • Bronze plans have the lowest monthly premiums, but they also have the highest out-of-pocket costs.
  • Silver plans have higher monthly premiums, but they also have lower out-of-pocket costs in comparison to Bronze plans. Sliver plans help provide more balance between monthly payments and out-of-pocket costs.
  • Gold plans offer lower out-of-pocket costs in exchange for higher monthly premiums.
  • Platinum plans have the highest monthly premiums and the lowest out-of-pocket costs of any health insurance plan available. Due to high monthly premiums, deductibles are very low, meaning your plan starts paying its share earlier than for other categories of plans.

What are Non-Marketplace Health Insurance premiums?

Non-Marketplace Health Insurance plans are not offered on the federal or state Health Insurance Marketplaces.

Both On-Marketplace and Off-Marketplace plans require payment of a premium, which is the amount you pay to the insurance company for your health insurance coverage.

Off-Marketplace plans may have lower premiums than plans offered on the Marketplaces.

How can I enroll in health coverage through the Marketplace?

To be eligible to enroll in health coverage through the health insurance marketplace, you:

How can I save money on my Marketplace plan?

Depending on your expected household income for the year, you may qualify for:

  • Lower costs for your Marketplace plan, like the premium tax credit that lowers your monthly insurance bill, and for extra savings on out-of-pocket costs like deductibles and copayments.
  • Coverage through Medicaid or the Children’s Health Insurance Program (CHIP). Your children may qualify for CHIP, even if you don’t qualify for Medicaid.

When does the Health Insurance Marketplace open?

  • November 1: Open enrollment starts for health coverage. This is the first day you can enroll in, re-enroll in, or change health plans through the Marketplace. Coverage can start as soon as January 1st.
  • December 15: Last day to enroll in or change plans for coverage to start January 1st.
  • January 1: Coverage starts for those who enroll in or change plans by December 15th.
  • January 15: Open enrollment ends. This is the last day to enroll in or change health plans for the year. After January 15th, you can enroll in or change plans only if you qualify for a special enrollment period.
  • February 1: Coverage starts for those who enroll in or change plans December 16th through January 15th.

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