What is an ACA marketplace plan?
An ACA plan is individual or family health insurance that follows the rules of the Affordable Care Act. Every plan covers the 10 essential health benefits, cannot turn you down or charge you more for a pre-existing condition, and has no annual or lifetime dollar limit on those essential benefits. You buy it yourself rather than getting it through an employer.
When can I enroll in an ACA plan?
Open Enrollment runs from November 1 through January 15 in most states. In most states, if you sign up by December 15 your coverage starts January 1, and if you sign up between December 16 and January 15 your coverage starts February 1. A handful of states run their own marketplace with a different deadline, so check the dates for your state before you decide.
What if I miss Open Enrollment?
You can still enroll if you have a qualifying life event such as losing other coverage, moving to a new area, getting married or divorced, having or adopting a child, or a change in income that affects your eligibility. That opens a Special Enrollment Period, and you generally have 60 days from the event to pick a plan. Medicaid and CHIP have no enrollment window at all: you can apply any time of year.
How do subsidies work?
The premium tax credit lowers what you pay each month for a marketplace plan. Eligibility and the amount depend on your household income, household size, where you live, and the cost of plans in your area. You can take the credit in advance so it is applied to your monthly premium, or claim it when you file your federal tax return. If your income qualifies you for cost-sharing reductions, you have to choose a Silver plan to get them.
What is the difference between Bronze, Silver, Gold, and Platinum?
The metal tiers describe how you and the plan split covered costs, not the quality of care. Bronze plans have the lowest monthly premium and the highest costs when you use care; Platinum is the reverse. All four tiers cover the same 10 essential health benefits, so the choice is mostly about how much care you expect to use and how you would rather pay for it.
Can I be denied coverage for a pre-existing condition?
No. Marketplace plans cannot refuse you, charge you more, or exclude treatment because of a health condition you already have. Premiums can vary only by age, location, family size, tobacco use, and the plan you choose.