The Health Insurance Marketplace, in one sentence: it's the official name for the government-run website — HealthCare.gov, or your state's own version — where you shop for and buy private health insurance if you don't get coverage through a job, Medicaid, or Medicare, with income-based help lowering the monthly bill. It's also called "the ACA Marketplace" or "the Exchange," but it's the same website and the same program.
Health Insurance Marketplace: Quick Facts
- What it is: a website, created by the Affordable Care Act (ACA), where you compare and buy private health plans. Every plan must cover ten essential health benefits, like hospital care, doctor visits, prescriptions, and check-ups.
- Who it's for: people who don't have coverage from a job, Medicaid, Medicare, the military, or the VA. You must live in the U.S. and be a citizen or eligible immigrant.
- Help paying: premium tax credits lower your monthly bill. Cost-sharing reductions lower what you pay when you use care, but only on Silver plans. The Marketplace tells you what you qualify for when you apply.
- Plan levels: Bronze, Silver, Gold, and Platinum, plus Catastrophic plans for some people under 30. Lower tiers cost less each month and more when you use care. Higher tiers are the reverse.
- When to enroll: during Open Enrollment each year, or within 60 days of a big life change like losing a job, moving, getting married, or having a baby.
- What's always covered: preventive care like shots, cancer screenings, and check-ups is covered at no cost on every Marketplace plan.
- Where to go: HealthCare.gov (or call 1-800-318-2596), or your state's own marketplace if it has one. Free help is available from Navigators and community health centers.
Is the ACA Marketplace right for me, or is it Medicaid or Medicare?
| If you... | Then look at | Why |
|---|---|---|
| Are under 65, have no job coverage, and have moderate income | The ACA Marketplace | You may get a tax credit that cuts your premium. |
| Have low income | Medicaid or CHIP (for children) | The Marketplace application checks this for you and sends you there if you qualify. You can't get both a Marketplace subsidy and Medicaid. |
| Are 65 or older, or qualify for Medicare through disability | Medicare | The Marketplace is not for people who have Medicare. See Turning 65. |
| Are offered coverage at work | Your job's plan, usually | The Marketplace application will tell you whether you can still get a tax credit. |
The sections below explain each of these points in more detail.
What Is the Marketplace?
The Health Insurance Marketplace (also called the Exchange) is a website where you can compare and buy private health insurance. You can use it if you don't have insurance from your job, Medicaid, Medicare, or another source. The Marketplace was created by the Affordable Care Act (ACA) and opened for enrollment in 2013.
The Marketplace operates at two levels:
- Federal Marketplace: HealthCare.gov works in most states.
- State Marketplaces: Some states run their own marketplaces with their own websites. Each state chooses to use HealthCare.gov or run its own site.
All Marketplace plans must cover essential health benefits. These include hospital stays, doctor visits, medications, and preventive care like check-ups.
Who Can Buy on the Marketplace?
You are generally eligible to use the Marketplace if you:
- Live in the United States and are a U.S. citizen or eligible immigrant;
- Don't have health insurance through an employer, Medicaid, Medicare, the military, or the VA;
- Are not a dependent claimed on someone else's taxes (with limited exceptions).
When you apply, the Marketplace checks your income and family size to see if you get help paying. You may qualify for:
- Premium tax credits: Money that lowers your monthly bill.
- Cost-sharing reductions: Lower costs when you use care.
You might also qualify for Medicaid or CHIP. If so, the Marketplace will tell you to apply for those instead. See "Marketplace and Other Programs" below.
Metal Tiers: Plans, Premiums, and Cost-Sharing
Marketplace plans come in five types: four metal tiers plus catastrophic. Each tier shows the balance between your monthly payment and what you pay for care.
Higher tiers have higher monthly payments but lower costs when you use care. Lower tiers have lower monthly payments but higher costs when you use care.
| Metal Tier | Premium | Cost-Sharing | Best For |
|---|---|---|---|
| Bronze | Lowest | Highest (you pay ~40% of health costs) | Younger, healthier people who rarely visit the doctor or those willing to tolerate higher deductibles for lower monthly costs |
| Silver | Low | Moderate (you pay ~30% of health costs) | People with expected routine care; also the tier where cost-sharing reductions apply |
| Gold | High | Low (you pay ~20% of health costs) | People with frequent medical needs or expecting regular prescriptions |
| Platinum | Highest | Lowest (you pay ~10% of health costs) | People with significant ongoing medical costs who want maximum coverage |
| Catastrophic | Very low | Highest deductible (protection for serious illness/injury only) | People under 30 or those with hardship; mainly protects against catastrophic costs |
The percentages above are averages, not exact numbers. Your actual costs depend on which plan you pick, what care you use, and if you get help paying.
Essential Health Benefits
All Marketplace plans must cover these ten categories of health services:
- Ambulatory (outpatient) services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative services and devices
- Laboratory services
- Preventive and wellness services
- Pediatric dental and vision care
Preventive care (like shots, cancer screenings, and check-ups) is covered at no cost. For more on how benefits affect your costs, see Understanding Your Costs.
Premium Tax Credits and Cost-Sharing Reductions
If your household income falls below a certain level, you may receive two types of financial assistance:
Premium Tax Credits
A premium tax credit lowers your monthly bill. The money goes straight to your insurance company, so you pay less each month. The amount depends on your income and family size. You must apply during open enrollment and tell them if your income changes. See how to estimate your income for Marketplace subsidies, and what happens at tax time if your estimate is off.
Did your bill jump this year? The temporary extra tax credits from 2021 have expired, so many people now pay a bigger share. See why your Marketplace premium went up for what changed and what you can do. Planning ahead? See Marketplace Open Enrollment 2027 dates. Turning 65 on a Marketplace plan? See when your savings stop and when to cancel.
Cost-Sharing Reductions (CSRs)
If eligible, CSRs lower the costs you pay when you use care. But CSRs only work with Silver plans. You cannot use them with Bronze, Gold, or Platinum. This makes Silver plans especially good if you expect to need medical care.
Important: Subsidies and credits can change due to new laws. Check Policy Changes for current rules. Income limits and cost amounts change each year and depend on family size. We don't list specific dollar amounts here because they change. Use HealthCare.gov to see what you qualify for during enrollment.
Enrollment Deadlines: Open Enrollment and Special Enrollment Periods
Open Enrollment
Open Enrollment is the time each year when you can sign up for a Marketplace plan or switch plans. It lasts a few weeks to a few months, depending on your state. Coverage usually starts January 1st. If you miss it and don't qualify for a Special Enrollment Period, you'll have to wait until next year to buy coverage.
Special Enrollment Periods (SEPs)
You can sign up or switch plans outside open enrollment if something major changes in your life, such as:
- Loss of health coverage (job loss, COBRA expiration, or losing Medicaid or CHIP)
- Turning 26 and aging off a parent's plan
- Change in family size (marriage, divorce, birth, adoption)
- Change in income
- Moving to a new state or ZIP code
- Becoming a U.S. citizen or eligible immigrant
You usually have 60 days after the event to sign up. For more details, see Enrollment & Deadlines.
How to Apply
Most people apply on HealthCare.gov. The application asks about your family size, income, citizenship, and current coverage. You get results right away and can see how much help you might get before you enroll.
If your state runs its own marketplace, apply on that state's website. Find it on HealthCare.gov or call your state insurance commissioner's office.
You can also get free help with your application from:
- Navigators: Government-funded counselors who help you compare plans and enroll
- Insurance brokers: Licensed professionals who sell and advise on plans
- Community health centers: Many offer free help with enrollment
To find help in your area, see Getting Help Paying.
Marketplace and Other Programs
Medicaid and CHIP
When you apply on the Marketplace, the system checks if you qualify for Medicaid or CHIP instead. If you do, you'll be told to apply for those programs. You cannot get both a Marketplace subsidy and Medicaid at the same time.
Medicaid and CHIP are free or cheap government programs for low-income people. If you think you qualify, apply through your state's Medicaid office or Benefits.gov.
Medicare
You cannot use the Marketplace if you qualify for Medicare. Once you turn 65 or qualify due to disability or ESRD (end-stage renal disease), you must enroll in Medicare Part A and Part B. Then you choose among Medicare options like Original Medicare, Medicare Advantage, or Medigap, plus Part D for prescriptions. Marketplace help doesn't apply to Medicare people. For questions about your choices at retirement or disability, see Medicare.gov.
Related Topics
To learn more about health coverage and costs, explore:
- Coverage Basics — overview of how health insurance works
- Understanding Your Costs — deductibles, copays, coinsurance, and out-of-pocket maximums
- Enrollment & Deadlines — when and how to sign up
- Getting Help Paying — resources for subsidies and financial assistance
- Policy Changes — recent updates to ACA rules and subsidies
- Mixed-Status Families — how the application treats each person when immigration statuses differ
Verify at the source: Marketplace rules and deadlines can change and are set by CMS (Centers for Medicare & Medicaid Services). This page is educational and current as of today. For the latest details, visit HealthCare.gov or CMS.gov. MediPrimer is independent and not affiliated with CMS, Medicare, Medicaid, any state, or any insurance company.