The Health Insurance Marketplace is a government-run service where individuals, families, and small businesses can shop for health insurance plans, compare coverage options, and access financial help to lower their costs. Created by the Affordable Care Act in 2010, it serves as a centralized place to find private health coverage, check eligibility for tax credits, and enroll in programs like Medicaid or the Children’s Health Insurance Program (CHIP).
How the Marketplace Works
The Marketplace functions like a regulated shopping platform for health insurance. You create an account, enter information about your household size and income, and the system shows you available plans in your area along with any financial assistance you qualify for. Every plan sold through the Marketplace must meet minimum coverage standards set by federal law, which means you won’t encounter bare-bones policies that leave major gaps.
To use the Marketplace, you need to live in the United States, be a U.S. citizen, national, or lawfully present non-citizen, and not be currently incarcerated. Residents of U.S. territories like Puerto Rico or Guam cannot enroll through the Marketplace unless they also qualify as a resident of one of the 50 states or Washington, D.C.
Federal vs. State Marketplaces
Not every state uses the same system. The federal government operates HealthCare.gov for states that don’t run their own exchange. For the 2026 plan year, 21 states plus D.C. run fully independent state-based exchanges with their own websites and enrollment platforms. Another 3 states operate hybrid models: they manage plan certification and consumer outreach locally but use the federal platform for eligibility and enrollment behind the scenes. If you’re unsure which applies to you, starting at HealthCare.gov will redirect you to the right place.
The Four Plan Levels
Marketplace plans are organized into four color-coded tiers based on how costs are split between you and the insurer. The tiers don’t reflect quality of care or the size of the doctor network. They reflect how much of a typical medical bill the plan covers versus how much comes out of your pocket.
- Bronze: The plan covers about 60% of costs, you pay 40%. Monthly premiums are the lowest, but you’ll pay more when you actually use care.
- Silver: The plan covers about 70%, you pay 30%. A middle-ground option, and the only tier that qualifies for extra out-of-pocket savings (more on that below).
- Gold: The plan covers about 80%, you pay 20%. Higher monthly premiums, but lower costs at the doctor’s office or hospital.
- Platinum: The plan covers about 90%, you pay 10%. The highest premiums with the lowest out-of-pocket costs when you need care.
If you rarely see a doctor and mostly want protection against a catastrophic event, a Bronze plan keeps your monthly bill low. If you have ongoing prescriptions, regular specialist visits, or a planned surgery, Gold or Platinum plans usually save money over the course of a year despite the higher premiums.
What Every Plan Must Cover
Federal law requires all Marketplace plans to cover 10 categories of essential health benefits. These include doctor visits, inpatient and outpatient hospital care, prescription drugs, pregnancy and childbirth, mental health and substance use treatment, rehabilitative services, lab tests, preventive care and chronic disease management, pediatric services (including dental and vision for children), and emergency services. Preventive care, such as annual checkups, vaccinations, and certain screenings, is covered at no cost to you before you meet your deductible.
Financial Help That Lowers Your Costs
Two types of financial assistance are available through the Marketplace, and many people qualify for both.
Premium Tax Credits
Premium tax credits reduce your monthly insurance bill. To qualify, your household income must be at least 100% of the federal poverty level. Through the end of 2025, enhanced subsidies (expanded by Congress in 2021 and extended through the Inflation Reduction Act) remove the traditional income cap of 400% of the poverty level, meaning even higher-income households may receive some help. If Congress does not extend these enhanced credits, the 400% cap returns in 2026 and subsidy amounts will shrink for many enrollees. The underlying tax credit itself does not expire, but the generous expansion does.
You can apply the credit directly to your monthly premium so you pay less each month, or claim it as a lump sum when you file your taxes. Most people choose the monthly reduction.
Cost-Sharing Reductions
Cost-sharing reductions lower what you pay when you actually use your insurance: smaller deductibles, lower copays, and reduced coinsurance. These savings are only available if you pick a Silver plan. Enrolling in a Bronze, Gold, or Platinum plan still lets you use premium tax credits, but you won’t get these extra out-of-pocket savings. The amount you save depends on your specific income. Lower incomes within the qualifying range receive the largest reductions. You’ll see your exact savings after you apply and browse Silver plans.
When You Can Enroll
The Marketplace has a fixed annual window called Open Enrollment. For coverage starting in January, Open Enrollment begins November 1 and runs through January 15. If you want your plan to kick in on January 1, you need to enroll or make changes by December 15. Enrolling between December 16 and January 15 means your coverage starts February 1.
Outside of Open Enrollment, you can sign up or switch plans only if you experience a qualifying life event that triggers a Special Enrollment Period. These events generally fall into a few categories:
- Losing existing coverage: Losing a job-based plan, aging off a parent’s insurance, losing Medicaid or CHIP, or any involuntary loss of qualifying coverage. You have a 60-day window around the date of the loss.
- Household changes: Getting married, having or adopting a baby, or placing a child in foster care. Divorce or legal separation counts only if it causes you to lose your insurance.
- Moving: Relocating to a new ZIP code or county, moving to the U.S. from another country, or moving to or from a school, seasonal work location, or transitional housing.
- Other events: Gaining citizenship, leaving incarceration, becoming a member of a federally recognized tribe, or being affected by a natural disaster.
How to Get Started
If your state runs its own exchange, you’ll use that state’s website. Otherwise, go to HealthCare.gov. You’ll need your Social Security number (or document number for lawfully present non-citizens), income information for everyone in your household, and details about any employer-sponsored insurance available to you. The application takes most people 30 to 45 minutes. Once submitted, you’ll receive an eligibility determination that tells you which plans you can buy, how much premium tax credit you qualify for, and whether you’re eligible for cost-sharing reductions or Medicaid instead.
Free help is available if you’d rather not navigate the process alone. The Marketplace funds trained assisters called Navigators, and you can also work with licensed insurance agents or brokers at no extra cost to you.