Alyssa Lane
The Affordable Care Act (ACA), also known as Obamacare, was enacted in 2010 to make affordable health insurance available to more people. Under the ACA, patients are protected from insurance companies refusing coverage based on sex or pre-existing conditions. To apply for ACA insurance in person, you can start by going to Healthcare.gov to find your state Health Insurance Marketplace. Each state has its own enrollment instructions, and you can apply for and enroll in a Marketplace plan through an approved partner, such as an insurance company or online health insurance seller. You can also use the Find Local Help tool to locate in-person assistance in your area.
| Characteristics | Values |
|---|---|
| Website | Healthcare.gov |
| Application | Complete an application with information about the people in your household and your income |
| Plan | Choose a plan |
| Payment | Pay your first premium, if needed |
| Enrollment | Each state's marketplace has its own enrollment instructions |
| Enrollment Period | Open enrollment each year |
| Special Enrollment | Available if you experience a life event like moving or having a baby, or if your household income is below a certain amount |
| Eligibility | Eligibility results will be mailed within 2 weeks |
| Help | Free help is available from certified assisters or agents, or through the Find Local Help tool |
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What You'll Learn
Find your state's Health Insurance Marketplace
To find your state's Health Insurance Marketplace, you can start by visiting Healthcare.gov. This website will direct you to your specific state's Marketplace, which is where you can then review the enrollment instructions for your state. Each state's Marketplace has its own set of instructions, so it's important to refer to the correct state.
The Affordable Care Act (ACA), enacted in March 2010, mandated the creation of a Marketplace or exchange in each state. However, the management and implementation of these exchanges vary across states. Some states, like California, have their own dedicated websites, such as Covered California, where you can apply for health insurance plans.
As of 2025, DC and 19 other states have fully state-run Marketplaces, with their own websites, call centers, and funding for Navigator programs. Twenty-eight states, on the other hand, rely entirely on the federal government for their Marketplaces, utilizing Healthcare.gov for both the website and customer service. Additionally, there are three states with state-based Marketplaces that use the federal platform for enrollment, while managing their own Marketplaces and funding their Navigator programs.
While you are not required to purchase coverage through the Marketplace, it is important to note that if you buy coverage outside of the exchange, you may not be eligible for premium tax credits or cost-sharing reductions, which are offered as incentives to shop in the Marketplace.
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Locate in-person assistance in your area
To locate in-person assistance in your area, you can use the following methods:
Use the Online Directory
The HealthCare.gov website has an online directory where you can search for local, Marketplace-certified help. You can set up an appointment to talk in person, over the phone, or via email. These individuals are trained and certified by the Marketplace to help you apply and enroll in a health plan, as well as inform you about any eligible savings or coverage options through Medicaid or CHIP.
Contact the Marketplace Call Center
The Marketplace Call Center offers free, non-biased personal help. They can guide you through the application process, help you compare plans, and enroll. They are available every day, except certain holidays, and can provide assistance in languages other than English. They can also direct you to local resources and organizations that offer in-person help.
Find Local Help by Searching by Location
On the HealthCare.gov website, you can search by your city, state, or ZIP code to find a list of local people and organizations that can assist you with the application process, choosing a plan, and enrolling. Some of these resources also offer help in languages other than English and provide in-person assistance.
Reach Out to Agents and Brokers
Agents and brokers are trained professionals certified to sell health plans in the state they are licensed in. They are generally paid by insurance companies when individuals they assist enroll in one of their plans. You can connect with a licensed agent or broker through the Help On Demand service offered by HealthCare.gov. They can help you complete your application and enroll in a Marketplace plan.
Navigators and Certified Application Counselors
Each year, the Centers for Medicare & Medicaid Services (CMS) grant awards to organizations serving as Navigators in FFM states. These Navigators help consumers prepare applications, establish eligibility, and enroll in coverage through the Marketplaces. They also assist in finding insurance affordability programs. Certified Application Counselor Designated Organizations (CDOs) oversee Certified Application Counselors (CACs) in FFMs, who are trained to help consumers seeking health insurance coverage options.
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Complete an application with household and income information
To apply for ACA insurance in person, you must complete an application with household and income information. This is a crucial step in the process, as it helps determine your eligibility for cost-saving reductions and premium tax credits. Here are the key steps and considerations to keep in mind:
Gather the Necessary Information:
Before you begin filling out the application, it's essential to have all the required information readily available. This includes details about yourself, your household members, income, and current health coverage. Having a checklist ensures a smoother application process.
Basic Personal Information:
Provide your basic personal details, such as your full name, address, date of birth, and contact information. You may also be asked optional demographic questions to help improve services.
Household Information:
Define who lives with you and who is part of your tax household. Specify the relationships between household members, including your spouse if filing jointly and any tax dependents. Remember to include information for everyone in your tax household, even if they aren't applying for coverage, as eligibility for savings is based on total household income.
Income Information:
Report your current monthly income and provide an estimated annual income for the upcoming coverage year for all relevant household members. Break down the income by type, including wages, self-employment income, unemployment benefits, and Social Security payments. You may also need to provide a recent federal tax return.
Current and Offered Health Coverage:
Disclose any current health coverage that you or any household members have, such as Medicaid, Medicare, or a job-based plan. Additionally, mention if anyone has been offered job-based coverage, even if they haven't enrolled.
Citizenship and Immigration Status:
Confirm the citizenship or immigration status for each person applying for coverage.
Update and Review:
Review your application thoroughly to ensure it is complete and accurate. Remember that you can update your income information online, by phone, or in person. If you experience any life changes, such as moving or having a baby, report these updates to the Marketplace to receive new eligibility results and adjust your coverage if needed.
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Choose a plan
Choosing an insurance plan can be complicated, but there are resources available to help you find the right plan for your needs. There are a few things to consider when choosing a plan. Firstly, you should know that there are four categories of health insurance plans: Bronze, Silver, Gold, and Platinum. These categories indicate how you and your plan share costs, but they do not indicate the quality of care. For example, with a Platinum plan, you pay 10% and the health insurance issuer pays 90%.
You should also consider the type of health plan. For instance, an HMO plan will usually only cover care from doctors who work for or are contracted by the HMO, and may require you to live or work in its service area. A POS plan will require you to get a referral from your primary care doctor to see a specialist, but you will pay less if you use doctors that belong to the plan's network.
When choosing a plan, you should consider both the monthly premium you will pay and the potential out-of-pocket costs. You can use public exchanges to shop, compare, and enroll in a plan with assistance from a licensed agent. You can also use healthcare shopping companies, which can help you compare plans, optimize health savings, and guide you through the shopping and enrollment process.
It's important to consider your health needs when choosing a plan. For example, if you have a preferred doctor or take a prescription drug, you should look for a plan that covers them. You can use HealthCare.gov to add your provider and prescriptions to see if they are covered by the plan.
Finally, make sure to check that the plan you choose is ACA-compliant. Some short-term plans may advertise lower monthly premiums, but they do not cover the ACA's ten essential benefits, such as prenatal care and mental health treatment.
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Pay your first premium
Paying your first premium is a crucial step in completing your ACA insurance application. Here are some detailed instructions to guide you through the process:
Understanding Premiums and Costs:
Firstly, it's important to understand that a premium is a monthly payment you make for your insurance plan. The amount you pay for your health insurance premium can vary depending on several factors, including your age, location, income, and the size of your household. Older individuals, for instance, may pay higher premiums than younger people. Additionally, the cost of living and healthcare services in your area can influence the premium amount.
Payment Methods:
Insurance companies handle payments differently, so it's essential to follow the instructions provided by your chosen insurance company. Some companies may offer online payment options through their websites, while others may have alternative methods. If your insurance company does not offer online payment, they should contact you with instructions on how to proceed.
Completing Your Enrollment:
Your enrollment in a health plan is typically not considered complete until the insurance company receives your first premium payment. Make sure to pay your first premium on time and directly to the insurance company, not the Marketplace. You can refer to your plan brochure or the insurance company's website to find their contact information.
Grace Periods and Consequences:
It is important to stay on top of your monthly premium payments to avoid losing your coverage. Most insurance companies provide a grace period, usually around three months, during which you can make the payment without losing coverage. However, if you fall behind on your monthly premiums, your insurance company may decide to end your coverage.
Premium Tax Credits:
If you are eligible, you can benefit from a premium tax credit, which helps lower your monthly premium payments. This credit is refundable and can be claimed when filing your tax return. The Marketplace will determine your eligibility for advance payments of the premium tax credit, and if applicable, the government will pay the credit directly to your insurer, and you will pay the remaining amount.
Remember to carefully review the enrollment materials and keep your health insurance card safe, as you will need it when accessing healthcare services.
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Frequently asked questions
The first step is to find your state Health Insurance Marketplace. You can do this by going to Healthcare.gov.
Each state's Marketplace has its own enrollment instructions. You will need to follow the instructions for your state to complete your application.
You will need to provide information about the people in your household and your income.
Most people apply for ACA insurance during the annual open enrollment period. If you miss the deadline, you may still be able to apply during a special enrollment period if you have experienced a major life event or meet a certain income level.
