What the Marketplace is and how to use it

The Health Insurance Marketplace is a website where you can compare health plans side by side, see what each one costs you personally, and enroll in coverage. It exists because the Affordable Care Act required a central place where individuals and families could shop for insurance without going through an employer. The federal Marketplace serves most states; a few states run their own versions.

You do not have to use the Marketplace to buy health insurance—you can buy directly from an insurance company. But the Marketplace has one major advantage: it shows you whether you may have access to for tax credits or cost-sharing reductions that lower your monthly premium or out-of-pocket costs. Those subsidies are only available through the Marketplace, not when you buy directly from an insurer.

The Marketplace is free to browse. You create an account, answer questions about your household and income, and the site tells you what financial help you might receive. Then you choose a plan and enroll. Open enrollment runs from November through January each year, though you can enroll outside that window if you experience a may have access to life event—like losing job-based coverage, moving states, or having a baby.

Key Takeaways

  • The Marketplace shows you plans from multiple insurers and calculates your personal cost, including any tax credits you may receive based on your income.
  • Tax credits and cost-sharing reductions that lower your monthly bill are only available if you enroll through the Marketplace, not if you buy directly from an insurance company.
  • You can browse and compare plans for free; enrollment happens during open enrollment (November through January) or after a may have access to life event.
  • The federal Marketplace serves most states at Healthcare.gov, while some states operate their own Marketplace websites.
  • Your income and household size determine what financial help you receive, so the Marketplace asks for this information before showing you plans and costs.

How to find your state's Marketplace and create an account

If you live in most states, you use the federal Marketplace at Healthcare.gov. A handful of states operate their own Marketplaces: California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming each have their own site or use a regional partner. You can find your state's Marketplace by searching "[your state] health insurance marketplace" or by visiting Healthcare.gov, which will direct you to the right place.

Once you land on your Marketplace, you create an account with an email address and password. You will then answer questions about your household—how many people live with you, their ages, and whether they have access to job-based insurance. You will provide your income (or estimate it if it has changed recently) and your Social Security number so the Marketplace can verify your information and calculate what financial help you may receive. This process usually takes 15 to 20 minutes.

After you submit your information, the Marketplace tells you whether you may have access to for tax credits (which reduce your monthly premium) or cost-sharing reductions (which lower what you pay when you use medical services). It also tells you whether you may may have access to for Medicaid, which is a separate program. If you do not may have access to for Medicaid, you will see a list of private insurance plans available to you.

Understanding plan types and what they cost you

The Marketplace shows you plans in four metal categories: Bronze, Silver, Gold, and Platinum. These names refer to how much of the cost the plan covers, not the quality of care. A Bronze plan covers about 60 percent of your medical costs on average, leaving you to pay 40 percent. Silver covers 70 percent, Gold covers 80 percent, and Platinum covers 90 percent. The trade-off is that Bronze plans have lower monthly premiums but higher deductibles and out-of-pocket costs when you use care. Platinum plans cost more per month but less when you actually go to the doctor.

Each plan also has a deductible (the amount you pay before the plan starts paying), a copay (a fixed amount you pay per visit), and a coinsurance (a percentage of the cost you pay). The Marketplace shows all of these numbers for each plan so you can compare them directly. You can also see which doctors and hospitals are in each plan's network, though you may need to visit the insurer's website for a complete list.

If you may have access to for a tax credit, the Marketplace applies it to the Silver plan price by default, which lowers your monthly bill. You can use that credit toward any plan you choose—Bronze, Gold, or Platinum—but if you pick a plan that costs less than Silver, you do not get the difference back as money. If you pick a plan that costs more, you pay the difference out of pocket. Cost-sharing reductions, which lower your deductible and copays, are only available with Silver plans.

Tax credits and cost-sharing reductions explained

A tax credit is money the federal government gives you to pay your monthly insurance premium. It is based on your income and household size. The Marketplace calculates how much you should receive based on the federal poverty level and your expected income for the year. If your actual income turns out to be different at tax time, you may owe money back or receive a refund, so it is important to update your income information if it changes during the year.

A cost-sharing reduction lowers the amount you pay when you use medical services—your deductible, copays, and coinsurance. You only may have access to for cost-sharing reductions if your income falls below a certain threshold (usually between 150 and 250 percent of the federal poverty level, depending on your household size), and you must enroll in a Silver plan to receive them. Cost-sharing reductions are automatic; you do not explore for them separately.

The amount of financial help you receive changes if your income or household size changes. If you get married, have a baby, lose a job, or experience another major life change, you can update your information on the Marketplace outside of open enrollment. The site will recalculate your help and show you updated plan prices. Some people's help increases; others' decreases. Updating your information keeps you from owing money back at tax time.

What happens after you choose a plan

Once you select a plan and enroll, your coverage usually starts on the first day of the following month. If you enroll between the 1st and 15th of a month, coverage begins on the 1st of the next month. If you enroll between the 16th and the end of the month, coverage begins on the 1st of the month after that. You will receive a confirmation email with your policy number and instructions for setting up an online account with your insurance company.

Your first premium payment is due by the date shown on your bill—usually the first of the month your coverage starts. You can pay by mail, phone, or online through your insurer's website. If you do not pay on time, your coverage may be canceled. If you receive a tax credit, the Marketplace sends that money directly to your insurance company to reduce your bill; you only pay the difference.

After your coverage starts, you can use your insurance card to see doctors, fill prescriptions, and get other medical care. Your insurance company's website usually has a tool to find in-network providers and check the cost of specific services before you go. If you need to make changes to your plan—switch to a different plan, add or remove family members, or update your information—you can do so during open enrollment or after a may have access to life event.

What counts as a may have access to life event

Outside of open enrollment, you can enroll in or change your Marketplace plan if you experience a may have access to life event. These include losing job-based health insurance, getting married or divorced, having a baby or adopting a child, moving to a new state, turning 26 and aging off a parent's plan, becoming a U.S. citizen or lawful resident, or experiencing a significant drop in income. Some states also include events like domestic violence or becoming homeless.

When you report a may have access to life event, the Marketplace gives you 60 days to enroll in or change your plan. You will need to provide proof of the event—a termination letter from your employer, a marriage certificate, a birth certificate, a lease showing your new address, or documentation of your income change. The Marketplace tells you what documents to submit and how to submit them when you report the event.

Frequently Asked Questions

Do I have to enroll through the Marketplace, or can I buy insurance directly from an insurance company?

You can buy directly from an insurer, but you will not see whether you may have access to for tax credits or cost-sharing reductions that way. Those subsidies are only available through the Marketplace. If you buy directly and later find out you may have access to for help, you cannot go back and claim it retroactively, so most people save money by shopping on the Marketplace first.

What if my income changes during the year?

You should update your income information on the Marketplace as soon as possible. If your income drops, you may may have access to for more financial help, and your monthly premium will go down. If your income rises, your help may decrease. Updating keeps you from owing money back when you file taxes. You can make changes outside of open enrollment by reporting a change in circumstances.

Can I switch plans after I enroll?

You can switch plans during open enrollment (November through January) without needing a reason. Outside that window, you can only switch if you experience a may have access to life event like losing job-based coverage, moving, or having a baby. If you want to switch for any other reason, you have to wait until the next open enrollment period.

What if I cannot afford any of the plans shown?

If all plans are unaffordable even with tax credits, you may may have access to for an exemption from the requirement to have insurance, which means you will not owe a penalty. You can also look into whether you may have access to for Medicaid, which is free or very low-cost and is separate from the Marketplace. Contact your state's Medicaid office or ask the Marketplace whether you may have access to.

How do I know if a doctor is in my plan's network?

Each plan's details page on the Marketplace includes a link to the insurer's provider directory. You can search by doctor name or location to see if they are in the network. You can also call the insurance company's customer service number (on the plan details page) and ask. Using in-network providers costs you less than out-of-network providers.