There are hundreds of health insurance plans to choose from in today’s healthcare landscape. Many Americans carry health insurance through an employer. But this doesn’t apply to everyone. Many other people, such as the self-employed, don’t have the option of employer-sponsored health insurance.

This is where a health insurance marketplace comes in. You may be wondering, “what is a health insurance marketplace?”. A health insurance marketplace is where you can shop for and compare health insurance plans. A marketplace may also be known as “the exchange.”

Federal or state governments run some health insurance marketplaces. Others, such as eHealth, are privately run health insurance exchanges. Keep reading to learn more about health insurance marketplaces and how you can use them to find insurance coverage for you and your family.

Understanding the health insurance marketplace

Navigating the health insurance marketplace is essential for individuals seeking comprehensive coverage. In this section, we’ll delve into key aspects of the health insurance marketplace to help you make informed decisions about your healthcare coverage.

What is a health insurance marketplace?

A health insurance marketplace is a platform where you can shop and sign up for affordable health insurance plans. A marketplace is sometimes called “the exchange.” Marketplaces sell health insurance policies that may be subsidized by the federal government, depending on your income and family size. If you qualify for a subsidized plan, your costs for health insurance premiums will be reduced.

Over 21.3 million individuals selected an Affordable Care Act Health Insurance marketplace plan during the Open Enrollment Period (OEP) in 2024.

Benefits of buying coverage on the marketplace

There are several key benefits of signing up for health insurance through a marketplace. For example, a wide range of plans is available on the exchange. This means you can look at many different plans in one convenient location to find the best one for your healthcare needs and budget. You can also find out if you qualify for subsidies that will lower your monthly insurance cost.

In addition, all marketplace plans will cover certain services for free, and many offer other benefits, such as reduced prescription drug prices. If you make sure to go to in-network providers, marketplace plans can also potentially save you thousands in healthcare costs each year.

All marketplace plans cover ten essential health benefits as required by the Affordable Care Act, including coverage for hospitalization, emergency care, maternal care, and lab tests, to name a few. You can also find additional types of coverage like dental and vision on a marketplace.

To understand what is specifically covered by your plan, contact your health insurance provider.

Types of health insurance marketplaces

Both the government and private companies run health insurance marketplaces. Of the 21.3 million people that signed up in 2024, 16.3 million made plan selections on the federal marketplace, and 4.9 million made plan selections on their state-based marketplace.

There are three types of marketplaces:

1. State government marketplaces. Depending upon where you live, your state may run a health insurance marketplace.
2. Federal government marketplace. Not all states have their own marketplace.  People who live in states that do not have a marketplace can use the federal government’s health insurance marketplace.
3. Private marketplaces. Private health insurance exchanges like eHealth offer a convenient way for people from all states to buy marketplace and alternative health insurance plans.  If you choose to get an ACA plan from eHealth, it will include the same essential Obamacare benefits you would get on a state or a federal health insurance marketplace. If you are entitled to federal subsidies, you will get the same amount of subsidies when purchasing insurance on the private marketplaces as you would on the government marketplaces.

You will always pay the same price for a marketplace plan no matter where you buy it. Your premiums and any subsidies you are eligible for will be identical on the federal and state exchanges and on private sites like eHealth.

Note that different people may pay different prices for their marketplace plans. That’s because premiums will vary based on your state, income, and household size. However, the price that you pay will not change from one site to another. You can be confident that you are not going to get a better price somewhere else for the same exact plan, so you can relax, and avoid hopping around to too many sources.

That said, eHealth can help you navigate and compare plans so you can find the lowest prices on the health insurance you want. We also don’t charge any additional fees for this superior shopping experience. Keep reading to learn about more differences between private exchanges like eHealth and the government Marketplace.

Essential health benefits covered by marketplace health insurance plans

In the realm of marketplace health insurance plans, the inclusion of Essential Health Benefits (EHBs) ensures comprehensive coverage for individuals and families. These benefits encompass a range of medical services and treatments, aiming to provide essential care and support to policyholders. Let’s delve into what these benefits entail:

• Coverage for Preventive Care: Marketplace plans prioritize preventive care, including screenings, vaccinations, and wellness visits, aiming to detect and address health issues before they escalate. By covering preventive services at little to no cost, these plans promote proactive healthcare management and disease prevention.
• Prescription Drugs: Access to prescription medications is a vital component of healthcare coverage. Marketplace plans typically provide coverage for a wide range of prescription drugs, ensuring individuals can afford necessary medications to manage chronic conditions and treat acute illnesses.
• Emergency Services: In times of urgent medical need, emergency services become indispensable. Marketplace plans offer coverage for emergency room visits, ambulance services, and urgent care, ensuring individuals have access to timely and lifesaving medical interventions without financial barriers.
• Essential Health Benefits form the cornerstone of comprehensive health insurance coverage. By encompassing key healthcare services and treatments, these benefits ensure that individuals receive the care they need to maintain their health and well-being. From preventive care to emergency services, the inclusion of EHBs in marketplace plans underscores the commitment to providing quality and accessible healthcare to all policyholders.

Eligibility and enrollment for marketplace health insurance

Who is eligible to buy health insurance through the marketplace?

In order to buy a marketplace health insurance plan, you must:

1. Live in the United States.
2. Be a U.S. citizen or national.
3. Not be incarcerated.
4. Not be covered by Medicare.

The health insurance marketplace is not only for individuals—you can also research health insurance coverage for your entire family. Small businesses can even utilize a marketplace to find health insurance plans. Private marketplaces, like eHealth, are versatile and allow you to choose from a wide variety of health insurance products.

Enrolling in marketplace health insurance plans

There are limitations on when you can sign up for insurance on the marketplace. Obamacare open enrollment specifies the specific period of the year when you can acquire new insurance or change your medical coverage. The open enrollment period can vary slightly between states, but the federal open enrollment period runs from November 1st to January 15th.

It’s worth noting that your coverage will only take effect by January 1st if you sign up by the preceding December 15th. However, may be able to enroll in medical coverage outside of this time of year—this is known as a special enrollment period—if you experience a qualifying life event. For instance, this could be job loss, marriage, the birth of a child, or moving to a different coverage area.

To enroll in marketplace health insurance plans, individuals can navigate the following steps:

1. Visit the Health Insurance Marketplace: Access the Health Insurance Marketplace either through Healthcare.gov (for states that utilize the federal marketplace) or the respective state’s marketplace website.
2. Create an Account: Create an account on the Health Insurance Marketplace platform by providing necessary personal information.
3. Complete the Application: Fill out the application form with details about household income, family members, and other relevant information.
4. Browse Plans: Explore available health insurance plans offered through the marketplace, comparing premiums, deductibles, and coverage options to find a suitable plan.
5. Choose a Plan: Select the health insurance plan that best meets your needs and budget.
6. Enroll: Complete the enrollment process by following the prompts and providing any additional information required.
7. Pay Premiums: Once enrolled, pay the required premiums to activate coverage.

By following these steps, individuals can successfully enroll in marketplace health insurance plans and secure vital coverage for themselves and their families.

Marketplace health insurance plan options and coverage levels

 When comparing marketplace health insurance plan options, it’s crucial to consider coverage levels and associated costs. Bronze plans are ideal for individuals who are relatively healthy and don’t anticipate frequent medical expenses. Silver plans are suitable for individuals who require moderate healthcare services and are willing to pay slightly higher premiums for reduced out-of-pocket costs. Gold plans are ideal for individuals with anticipated medical needs or chronic conditions who can afford higher monthly premiums to minimize out-of-pocket expenses. Platinum plans are suitable for individuals who require frequent medical care or have complex medical conditions and are willing to pay higher premiums for extensive coverage and minimal out-of-pocket expenses. Ultimately, the choice depends on individual healthcare needs, budget, and preference for coverage versus cost.

Available plan categories: Bronze, Silver, Gold, and Platinum

 When exploring marketplace health insurance plan options, it’s essential to consider various factors, including coverage levels and costs. Here are the plan options based on coverage levels and associated costs:

1. Bronze Plans: Bronze plans typically offer the lowest monthly premiums but come with higher out-of-pocket costs. These plans cover about 60% of healthcare costs, leaving the remaining 40% to be paid by the insured through deductibles, copayments, and coinsurance.
2. Silver Plans: Silver plans strike a balance between monthly premiums and out-of-pocket costs. They cover about 70% of healthcare expenses, with the insured responsible for the remaining 30%.
3. Gold Plans: Gold plans have higher monthly premiums but offer more extensive coverage, covering approximately 80% of healthcare costs.
4. Platinum Plans: Platinum plans have the highest monthly premiums but provide the most comprehensive coverage, covering about 90% of healthcare costs.

Additionally, marketplace health insurance plans may offer different types of networks, such as Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), or Exclusive Provider Organization (EPO). Consideration should also be given to factors such as deductibles, copayments, coinsurance, and annual out-of-pocket maximums when comparing plan options.

Available types of insurance plans

Signing up on a marketplace for health insurance gives you access to several types of health insurance plans. These types of major medical health insurance plans comply with the Affordable Care Act and provide the ten essential benefits:

• Employer-sponsored plans or group insurance for small businesses
• Obamacare individual and family plans
• Subsidized health insurance plans, known as Qualified Health Plans
• Government-sponsored plans such as Medicaid and Medicare

You’ll also find catastrophic plans that only cover the ten essential benefits, and no other benefits.

Understanding deductibles, copayments, and out-of-pocket maximums

Understanding deductibles, copayments, and out-of-pocket maximums is essential for making informed decisions about healthcare coverage.

A deductible is the amount of money you must pay out of pocket for covered services before your insurance plan begins to pay. For example, if you have a $1,000 deductible, you’ll need to pay the first $1,000 of covered healthcare expenses before your insurance kicks in. Deductibles can vary widely between plans and can apply to different types of services, such as doctor visits, prescriptions, or hospital stays.

Copayments are fixed amounts you pay for covered services, typically due at the time of service. For example, you might have a $20 copayment for a doctor’s visit or a $10 copayment for a prescription. Copayments can vary depending on the type of service and your specific insurance plan.

Out-of-pocket maximums are the maximum amount of money you’ll have to pay for covered services in a given year. Once you reach your out-of-pocket maximum, your insurance plan will generally cover 100% of covered expenses for the rest of the year. This provides financial protection and ensures that your healthcare costs are limited, even if you have a serious illness or injury.

Understanding these costs is crucial because they directly impact your healthcare expenses and financial responsibility. By knowing your deductible, copayments, and out-of-pocket maximums, you can budget for healthcare costs and choose a plan that best meets your needs and financial situation. Additionally, understanding these costs can help you make informed decisions about when to seek medical care and how to manage your healthcare expenses throughout the year.

Financial assistance and resources

Navigating healthcare expenses can be daunting, but financial assistance and resources are available to help alleviate the financial burden. In this section, we’ll explore various programs and resources designed to provide support and aid individuals in managing their healthcare costs effectively.

Cost reductions and subsidies

Cost reductions and subsidies play a crucial role in making healthcare more affordable for individuals and families. Premium Tax Credits are designed to lower monthly premiums by providing financial assistance based on income and household size. Cost-Sharing Reductions further alleviate out-of-pocket costs by reducing deductibles, copayments, and coinsurance for eligible individuals. Calculating eligibility for these financial assistance programs is based on income and household size, ensuring that those who need support the most can access affordable healthcare options. Understanding these programs can help individuals make informed decisions about their healthcare coverage and manage their healthcare expenses effectively.

Medicaid and CHIP through the marketplace

Medicaid and the Children’s Health Insurance Program (CHIP) are vital healthcare programs aimed at providing coverage to low-income individuals and families. Through the marketplace, eligible individuals can access Medicaid and CHIP coverage, ensuring essential healthcare services for themselves and their children. Eligibility criteria for these programs vary by state but generally consider factors such as income, household size, and citizenship status. Applying for Medicaid and CHIP assistance is typically done through the marketplace website, where applicants can fill out an online application or seek assistance from trained navigators to facilitate the process. Understanding the availability and application process for Medicaid and CHIP through the marketplace can help eligible individuals and families access the healthcare coverage they need to stay healthy and thrive.

Do I have to get my plan through the health insurance marketplace?

If you want to apply for government subsidies, you do need to enroll in a plan on a state, federal, or private health insurance marketplace like eHealth that has a direct enrollment agreement with CMS. However, not everyone wants to get a marketplace plan. For example, you might not qualify for government subsidies, or you might find that a non-exchange plan better suits your needs.

If you go to a state or the federal health insurance marketplace, you will see only the exchange plans. However, on eHealth, you will see both on-exchange and off-exchange plans. In many cases, that means you will have a choice of more plans on eHealth than you would on a government health insurance marketplace.

The convenience and large selection you’ll find on eHealth makes shopping for health insurance much easier. You will be able to compare the costs and benefits of on-exchange and off-exchange plans at the same time, all in one place. This eliminates the hassle and frustrations of trying to compare plans on different sites. Visit eHealth to start learning more about health insurance and getting quotes on quality health insurance plans in your area.