Marketplace Health Insurance

Open Enrollment happens every fall, but certain life events, may qualify you to enroll in or change Marketplace health plans outside the yearly Open Enrollment Period.

Losing health coverage

Losing Medicaid or “CHIP” coverage

Moving

Getting married

Having a baby

Adopting a child

And More…

3 things to know before you pick a health insurance plan

How to Choose a Plan in the Health Insurance Marketplace®

Choosing a health insurance plan can be complicated. Knowing just a few things before you compare plans can make it simpler.

  • The 4 “metal” categories: There are 4 categories of health insurance plans: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. Plan categories have nothing to do with quality of care.

  • Your total costs for health care: You pay a monthly bill to your insurance company (a "premium"), even if you don’t use medical services that month. You pay out-of-pocket costs, including a deductible, when you get care. It’s important to think about both kinds of costs when shopping for a plan.

  • Plan and network types — HMO, PPO, POS, and EPO: Some plan types allow you to use almost any doctor or health care facility. Others limit your choices or charge you more if you use providers outside their network.

What Marketplace health insurance plans cover

All plans offered in the Marketplace cover these 10 essential health benefits:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)

  • Emergency services

  • Hospitalization (like surgery and overnight stays)

  • Pregnancy, maternity, and newborn care (both before and after birth)

  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

  • Prescription drugs

  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

  • Laboratory services

  • Preventive and wellness services and chronic disease management

  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

Additional benefits

Plans must also include the following benefits:

Essential health benefits are minimum requirements for all Marketplace plans. Specific services covered in each broad benefit category can vary based on your state’s requirements. Plans may offer additional benefits, including:

  • Dental coverage

  • Vision coverage

  • Medical management programs (for specific needs like weight management, back pain, and diabetes)

When comparing plans, you’ll see exactly what each plan offers.


Health coverage if you're self-employed

If you're self-employed, you can use the individual Health Insurance Marketplace® to enroll in flexible, high-quality health coverage that works well for people who run their own businesses.

You’re considered self-employed if you have a business that takes in income but doesn’t have any employees.

You can enroll through the Marketplace if you’re a freelancer, consultant, independent contractor, or other self-employed worker who doesn’t have any employees.