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What is the Health Insurance Marketplace?
What is the Health Insurance Marketplace?
April 17, 2025 | 6 min read
The Health Insurance Marketplace, or Health Insurance Exchange, is like a one-stop shop where you can browse and sign up for health insurance plans. It was set up through the Affordable Care Act (ACA) to help individuals, families, and small businesses find the right coverage. You can compare different plans from various insurance companies to see which one fits your needs and budget best. The Marketplace also helps you figure out if you qualify for financial assistance, like premium tax credits or cost-sharing reductions, to make your insurance more affordable. You can shop the Health Insurance Marketplace at healthcare.gov.
Health Insurance and the Affordable Care Act
The Affordable Care Act (ACA), often called Obamacare, is a federal law enacted in 2010. Its purpose was to make health insurance more accessible and affordable for Americans. In addition to setting up the Health Insurance Marketplace, the ACA introduced several other key changes. These include things like requiring insurance companies to cover pre-existing conditions and allowing young adults to stay on their parents' plans until age 26. The goal of the ACA was to ensure more people have access to quality health care without the financial strain.
To be eligible to enroll in a marketplace health insurance plan, you must be a non-incarcerated citizen living in the United States.
How Marketplace Insurance Works
The ACA has several rules in place regarding how and when you can sign up for Marketplace health insurance, and what kind of benefits and plans are available.
Open enrollment
You can enroll in a plan on the Health Insurance Marketplace only during certain times. Open enrollment is just what it sounds like, it’s typically open to everyone who is eligible. It usually takes place from November 1 – January 15 each year, but it may differ in some states.
Special enrollment
If you miss the open enrollment period, you may qualify to enroll during a special enrollment period. A special enrollment period is a limited window of time where you can enroll if you’ve experienced certain life changes, like moving or losing access to existing coverage.
Metal levels
The Health Insurance Marketplace offers plans categorized by metal levels: Bronze, Silver, Gold, and Platinum. Each metal level corresponds to a different balance of premiums and out-of-pocket costs. Bronze plans typically have the lowest premiums but higher out-of-pocket costs, while Platinum plans have the highest premiums but lower out-of-pocket costs. Silver and Gold plans fall in between, offering a balance of premium and out-of-pocket costs. These levels help you choose a plan that fits your budget and healthcare needs.
Subsidies
Subsidies on the Health Insurance Marketplace, also known as premium tax credits, are financial assistance provided by the government to help lower the cost of health insurance premiums. These subsidies are designed to make coverage more affordable for individuals and families with lower to moderate incomes. The amount of the subsidy you receive depends on your income and household size, and it is applied directly to your monthly premium, reducing the amount you have to pay. Eligibility for subsidies is determined when you apply for coverage through the Marketplace.
How to Get Started with Marketplace Health Insurance
- Find out all the documentation you need to get started via our handy checklist.
- Enroll directly with our Ambetter Health agents (844-933-0380).
- Shop and compare Ambetter Health plans.
- Or shop all plans in your state at Healthcare.gov.
Are you ready to find an affordable health insurance plan to meet your needs and budget? Shop our plans today, or call our helpful team at 844-933-0380 (TTY: 711) from 8 a.m. to 9 p.m. ET.
Questions about the Health Insurance Marketplace
The Health Insurance Marketplace and the Affordable Care Act (ACA) are related but not exactly the same. The ACA is the broader law that aims to make health insurance more accessible and affordable, while the Health Insurance Marketplace is a specific part of the ACA where you can shop for and enroll in health insurance plans. Think of the ACA as the big picture, and the Marketplace as one of its key tools to help you get covered.
The Health Insurance Marketplace is open to people who are U.S. citizens or legal residents who are not currently incarcerated. People with Medicare are not eligible to receive coverage through the Health Insurance Marketplace. Find out more about the eligibility rules for Marketplace Health plans.
Not all health insurance Marketplace plans have the same benefits, but they do have to cover a set of essential health benefits. These include things like hospital stays, doctor visits, prescription drugs, and preventive care. However, the specific details, like deductibles, copayments, and which doctors and hospitals are in-network, can vary from plan to plan. It’s a good idea to compare different plans to find one that best meets your health needs and budget.
Yes, where you live can significantly affect the kinds of plans available in the Health Insurance Marketplace. Each state, and sometimes even different regions within a state, may have different insurance providers and plan options. The availability of specific plans, the network of healthcare providers, and the cost of premiums can vary widely depending on your location.
Yes, you can keep your Marketplace plan even if you get a job that offers health insurance. However, if you choose to keep your Marketplace plan, you may no longer be eligible for premium tax credits or other subsidies, as these are generally available only to those who do not have access to affordable employer-sponsored coverage.
Adults are not required to have health insurance through federal law. Keep in mind though that some states do have mandates for individual healthcare coverage. Check with your state to find out what the requirements are where you live.
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Find the affordable plan that's right for you.
Or call our helpful team:
844-933-0380 (TTY: 711)
8 a.m. to 9 p.m. ET
Related Articles
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Understanding Health Insurance Marketplace Open Enrollment
Understand the key dates and your affordable insurance options.
What is a Special Enrollment Period
Understand if you qualify for a special enrollment period.
Health Insurance Metal Levels
Understand the different metal level tiers of health insurance plans.
Health Insurance Subsidies
Subsidies can help make your insurance premiums more affordable.
Ways to Save: Premium Tax Credits
You may be able to save with a premium tax credit.
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