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Glossary
The health insurance Marketplace, also called the exchange, is where you can buy health insurance under the Affordable Care Act.
Most states use the federal marketplace, HealthCare.gov (opens in new tab). However if you live in any of the states listed here (opens in new tab), your state has set up its own insurance marketplace. Here's what you need to know.
Who is it for?
You can use the health insurance marketplace for your state to buy a health insurance plan if you don’t already have health insurance through your job, CHIP (opens in new tab), or Medicaid (opens in new tab). If you do have insurance through your job, you can switch to a discounted marketplace plan only if your employer’s plans are considered “unaffordable.” Employer-provided insurance is considered unaffordable if the premium for the lowest-cost individual plan costs more than 9.66% of your household income. You still purchase a full-priced marketplace plan during Open Enrollment (opens in new tab). You can’t switch to a marketplace plan if you have CHIP or Medicaid.
What kinds of health insurance can I buy?
There are four types (or “tiers” (opens in new tab)) of plans on the health care marketplace: Bronze, Silver, Gold, and Platinum. All of these plans must offer minimum essential health benefits (opens in new tab), which include things like emergency services and prescription medications.
When you apply, you’ll find out if you qualify for subsidies that lower the cost of your insurance. You’ll also find out if you qualify to sign up for catastrophic coverage, Medicaid, or CHIP.
When can I enroll through the insurance marketplace?
Every year, you can buy health insurance, switch plans or renew your plan through the marketplace during Open Enrollment, which usually lasts from November 1 to January 15. After Open Enrollment ends, Special Enrollment (opens in new tab) begins. During Special Enrollment you can enroll in a marketplace plan only if you:
How do I get started?
You can use the healthcare marketplace in a couple of ways:
Can I get health insurance outside of the marketplace?
If aren’t eligible for subsidies, you can sign up for the same marketplace plans outside of the marketplace. You can sign up directly with Oscar or through a third party broker. This is called enrolling off-exchange. Get a quote (opens in new tab) to see if you qualify for subsidies (opens in new tab).
Keep in mind that if you don’t enroll through the Marketplace, you won’t be eligible to receive subsidies for the remainder of the year. You should only enroll off-exchange if you are confident that you won’t be applying for subsidies this year!
It’s also possible to sign up for a plan that’s not offered on the health insurance marketplace. These plans still must follow all of the same rules as marketplace plans. In other words, you can only sign up during the same periods, and plans must offer at least the same essential coverage. You may want to consider shopping outside of the marketplace if you don’t qualify for subsidies, as you can sometimes find a plan with additional benefits that’s better for you.