Marketplace Insurance: Millions Enrolled

The Health Insurance Marketplace is a service run by the federal government that helps people, families, and small businesses compare health insurance plans for coverage and affordability. During the 2024 Open Enrollment Period, a record-breaking 21.3 million people selected an Affordable Care Act (ACA) Health Insurance Marketplace plan. This includes over five million new people and 16 million who renewed their coverage. The Marketplace offers health plan benefits similar to those found in employer-sponsored health insurance plans, such as doctor visits, outpatient care, prescription drugs, emergency care, and mental health services. The average cost of health insurance through the marketplace is $469 a month for a 40-year-old individual.

Who can get marketplace coverage?

The Health Insurance Marketplace is an option for those who can't get an employer-sponsored health insurance plan. ACA health plans, also known as Obamacare, offer comprehensive coverage and are the only type of health insurance with premium tax credits that reduce the cost of health insurance for those who qualify.

There are two types of health insurance marketplaces: the federal marketplace and state-run marketplaces. The federal marketplace is run by the federal government at healthcare.gov and is used by most states to offer health insurance plans to their residents. Over a dozen states have their own state-run marketplaces with websites that differ in layout but provide the same essential information about plans and allow users to see if they qualify for a subsidy. To do this, the user simply enters their ZIP code, household income, and family size, and the marketplace will show them plans available in their area and offer cost estimates for each.

There aren't strict eligibility requirements for ACA health insurance plans, but to qualify for a marketplace health insurance plan, you must be a U.S. citizen or national. Households with incomes between 100% and 400% of the federal poverty level receive premium tax credits to lower health care costs. If your household income is below 138% of the federal poverty level, you will likely qualify for Medicaid, a federal/state health insurance program with low or no costs based on your income.

The annual open enrollment period for the federal marketplace is from November 1 to January 15, with slight variations in dates for state-run marketplaces. Outside of the yearly open enrollment period, you can get coverage or change plans if you qualify for a Special Enrollment Period, which occurs when you experience a qualifying life event such as losing your health insurance coverage, having a baby, getting divorced, or moving to a new ZIP code.

How does marketplace insurance work?

The Health Insurance Marketplace, also known as the Health Insurance Exchange, was created by the Affordable Care Act (ACA) or Obamacare. It is a place where people in the US can compare and purchase ACA-compliant individual and family health insurance plans. The Marketplace is an easy way for people to find health insurance plans available in their area.

The Marketplace offers health plan benefits similar to those found in employer-sponsored health insurance plans, including doctor visits, outpatient care, prescription drugs, emergency care, and mental health services. The main difference is that the Marketplace indicates a health plan's costs by metal tier: platinum, gold, silver, and bronze. These tiers allow consumers to compare the benefits and costs of different plans.

The average cost of health insurance through the Marketplace is $469 a month for a 40-year-old individual. The cost of a plan will depend on the metal tier chosen. Bronze and silver plans have the lowest premiums but higher out-of-pocket costs compared to gold or platinum plans.

There are two types of Marketplaces: the federal Marketplace and state-run Marketplaces. Most states use the federal Marketplace, which is run by the federal government at healthcare.gov. Over a dozen states have their own state-run Marketplaces, which may have different website layouts but provide the same essential information about plans and allow consumers to compare plans in their area.

To qualify for a Marketplace health insurance plan, individuals must be US citizens or nationals. People can qualify for cheaper health insurance based on household income and size. Households with incomes between 100% and 400% of the federal poverty level receive premium tax credits to lower healthcare costs.

Individuals can apply for Marketplace coverage in several ways: with help from someone in their community, through an agent or broker, through certified enrollment partner websites, or with a paper application.

As of early 2023, there were more than 16.3 million Americans enrolled in Marketplace plans, with 21.3 million people selecting a plan during the 2024 Open Enrollment Period.

What's covered by marketplace plans?

As of the 2024 Open Enrollment Period, 21.3 million people selected an Affordable Care Act (ACA) Health Insurance Marketplace plan. This includes over five million new customers and 16 million people who renewed their coverage.

ACA health plans, also known as Obamacare, offer comprehensive coverage and are the only type of health insurance with premium tax credits that reduce the cost of health insurance for those who qualify.

All Marketplace plans cover the following 10 essential health benefits:

• Prescription drugs
• Emergency services
• Hospitalization
• Laboratory services
• Mental health and substance use disorder services
• Pregnancy, maternity, and newborn care
• Preventive and wellness services
• Rehabilitative and habilitative services and devices
• Pediatric services, including oral and vision care
• Birth control and breastfeeding coverage

Additional Benefits

Some plans may also offer:

• Vision and/or dental services
• Medical management programs for specific health problems, such as diabetes and back pain
• Coverage for pre-existing conditions

Metal Tiers

The health insurance marketplace categorizes plans into four metal tiers: bronze, silver, gold, and platinum. These tiers indicate the costs of the plan, with bronze and silver plans having lower premiums but higher out-of-pocket costs compared to gold or platinum plans.

What are the types of health insurance marketplaces?

The Health Insurance Marketplace helps people find and enrol in affordable health care coverage. It was set up by the Affordable Care Act (ACA) to let people compare health plans offered by private health insurance companies.

There are two types of health insurance marketplaces:

The Federal Marketplace

Run by the federal government at healthcare.gov, most states use this to offer health insurance plans to their residents.

State-Run Marketplaces

Over a dozen states have their own state-run marketplace. The website layouts may differ, but each state provides information about plans available and allows users to enter household income data to see if they qualify for a subsidy. Users can enter their ZIP code, household income and family size, and the marketplace will let them compare plans available in their area. It also offers cost estimates for each available plan.

The Health Insurance Marketplace helps people find health coverage that fits their needs and budget. Every health plan in the Marketplace offers the same set of essential health benefits, including doctor visits, preventive care, hospitalization, prescriptions, and more.

The ACA health plans, sometimes called Obamacare, offer comprehensive coverage. They’re also the only type of health insurance with premium tax credits that reduce the cost of health insurance, if you qualify.

How to get marketplace health insurance?

As of 2024, 21.3 million people chose an Affordable Care Act (ACA) Health Insurance Marketplace plan during the Open Enrollment Period. This includes around 5 million new members and 16 million people who renewed their coverage.

The ACA health insurance marketplace is an option if you cannot get an employer-sponsored health insurance plan. ACA health plans, also known as Obamacare, offer comprehensive coverage and are the only type of health insurance with premium tax credits that reduce the cost of health insurance if you qualify.

How to Get Marketplace Health Insurance

The Health Insurance Marketplace is a service that helps people shop for and enrol in health insurance. The federal government operates the Health Insurance Marketplace, available at HealthCare.gov, for most states. Some states, however, run their own marketplaces.

• Check if you can enrol: Preview health plans and prices to get an estimate.
• Create a Marketplace account: Enter basic information, such as your name, address, and email address to start. If your state runs its own marketplace, you will be redirected there.
• Get "Eligibility Results": Submit your application to find out if you qualify for a Marketplace health insurance plan with savings.
• Enrol in health coverage: Compare health plans and prices available in your area and enrol in the one that best meets your needs.
• Pay your premium: Pay your monthly premium directly to the insurance company for your coverage to start.

You can apply for coverage in several ways:

• With the help of someone in your community
• Through an agent/broker
• Through certified enrolment partner websites
• With a paper application

Frequently asked questions