he Health Insurance Marketplace, (also known as The Exchange) offers health insurance plans for individuals and families who do not get coverage through their employer, Medicare, Medicaid, or other sources. Here's a breakdown of who qualifies, when to apply, and how to do it:
You must be a U.S. citizen or a lawfully present resident in the U.S. to qualify for Marketplace insurance.
Certain immigrants may also qualify for Marketplace coverage, depending on their status.
If your employer does not offer health insurance or if the insurance is not considered "affordable" (premiums for employee-only coverage are more than 9.12% of household income in 2024), you can qualify for Marketplace coverage.
If you qualify for Medicare or Medicaid, you are not eligible for the Marketplace.
If you earn between 100% and 400% of the Federal Poverty Level (FPL), you may qualify for subsidies in the form of premium tax credits and cost-sharing reductions.
In 2024, the FPL is about $14,580 for individuals and $30,000 for a family of four.
Higher-income households may also qualify for premium tax credits due to changes under the American Rescue Plan and Inflation Reduction Act, which expanded subsidy eligibility.
Small businesses can use the Small Business Health Options Program (SHOP) marketplace to offer health coverage to employees.
If you have lost health insurance due to job loss, life events (like divorce or birth of a child), or aging out of a parent’s plan, you may qualify for Marketplace coverage.
The main time to apply for health insurance through the Marketplace is during the Open Enrollment Period, which typically runs:
November 1 to January 15 each year.
If you enroll between November 1 and December 15, your coverage will begin on January 1.
If you enroll between December 16 and January 15, coverage typically starts on February 1.
You can apply outside the Open Enrollment Period if you experience a qualifying life event. These events trigger a Special Enrollment Period, which lasts for 60 days following the event.
Common qualifying life events include:
Loss of health coverage (e.g., job loss, aging out of a parent’s plan at 26).
Change in household (e.g., marriage, divorce, birth, or adoption of a child).
Change of residence (e.g., moving to a new state or ZIP code).
Other qualifying events like a change in income that affects your eligibility for tax credits or Medicaid.
You can apply for Medicaid or CHIP through the Marketplace at any time, and there is no deadline for these programs.
Visit HealthCare.gov (or your state’s Marketplace site if applicable) to create an account and apply for coverage.
The online application will guide you through entering personal details, income information, and household size to determine eligibility for plans and subsidies.
Call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) to apply or get assistance with your application.
You can apply with the help of a Licensed Agent or Broker, Navigator or Certified Application Counselor, who can provide free assistance.
Find local help through HealthCare.gov’s local assistance tool.
You can also apply in person at a state Medicaid office or local government health agencies.
Download and print a paper application from HealthCare.gov, complete it, and mail it to the address provided on the form.
If you qualify based on income, the following forms of financial assistance are available through the Marketplace:
Premium Tax Credits:
These reduce the amount you pay for monthly premiums. The tax credits can be applied directly to your monthly premiums.
Cost-Sharing Reductions (CSRs):
If your income is between 100% and 250% of the Federal Poverty Level, you may qualify for reduced out-of-pocket costs (such as lower deductibles, co-payments, and coinsurance).
Medicaid and CHIP:
If your income is low, you may be eligible for Medicaid or Children's Health Insurance Program (CHIP) instead of Marketplace coverage.
Affordable Health Insurance:
The Marketplace provides a wide range of coverage options, often with financial help based on your income, making health insurance more affordable.
Comprehensive Coverage:
All Marketplace plans cover the essential health benefits, including hospital stays, prescription drugs, maternity care, mental health services, and preventive services like vaccinations and screenings.
Subsidies for Eligible Individuals:
Many people qualify for tax credits or cost-sharing reductions, making healthcare more accessible and affordable.
Guaranteed Coverage:
You cannot be denied coverage for pre-existing conditions, and all Marketplace plans must comply with the Affordable Care Act’s consumer protections.
Applying for health insurance through the Marketplace ensures you have access to quality healthcare, often with financial support to lower costs, and helps avoid tax penalties for not having coverage.
