Health insurance and Marketplace coverage
What the Health Insurance Marketplace is, what decides whether you can get help paying for a plan, and how to check where your household stands before you apply.
About this coverage
The Health Insurance Marketplace is the government-run place to buy individual and family health coverage — the one most people mean by “Obamacare” or “an ACA plan”. It exists for people who do not get coverage through an employer: the self-employed, people between jobs, early retirees not yet on Medicare, and anyone whose employer does not offer a plan.
Two things make it different from buying insurance anywhere else. You cannot be turned down or charged more for a health condition, and depending on your household income you may pay less than the listed price because a premium tax credit covers part of it.
What you would actually pay depends on your household, your income, your ZIP code and the plan you choose — which is why nobody, including this site, can tell you a price without your application. What can be worked out beforehand is whether you are in the range the savings are designed for, and that is a calculation you can do yourself.
ACA Savings Screener
Compares your household income against the published federal poverty guidelines for your household size, state and plan year, and tells you which range you fall in.
Free, and it asks for no contact details.
How the savings are decided
The premium tax credit is worked out from your household income expressed as a percentage of the federal poverty guideline for a household of your size. Those guidelines are published every year by the Department of Health and Human Services, and there are three of them: one for the 48 contiguous states and DC, one for Alaska and one for Hawaii.
One detail catches almost everyone out. The guidelines that govern a plan year are the ones published the previous calendar year — 2026 coverage is measured against the 2025 table. Using the newest figures gives the wrong answer for most of the year.
The income the Marketplace uses is not simply a salary. It is broadly your adjusted gross income plus any untaxed Social Security benefits, tax-exempt interest and excluded foreign income, for everyone on your tax return. And the Marketplace asks what you expect to earn in the coverage year, not what you earned last year — which matters if your income varies.
What an offer of employer coverage changes
This is the factor that changes the answer more than income does. If an employer offers you coverage that counts as affordable and meets the minimum value standard, you generally cannot get a premium tax credit — however low your income is.
“Affordable” has a specific meaning: it depends on what you would pay for the lowest-cost self-only plan the employer offers, relative to your household income. The threshold is set each year, so it is worth checking the current figure rather than assuming.
An offer that does not extend to your spouse or children may still leave them able to use the Marketplace. This is a common situation and a common reason people wrongly assume the Marketplace is closed to their family.
When you can enrol
Open Enrolment is the annual window when anyone can sign up or change plans. Outside it you need a Special Enrolment Period, which is triggered by a life event — losing other coverage, moving, marriage, a birth or adoption, and some changes in income or household.
Medicaid and the Children’s Health Insurance Program have no enrolment window at all. If your income falls in their range you can apply at any point in the year, and a single Marketplace application screens for both.
Dates shift, so check the current window on HealthCare.gov rather than relying on last year’s.
Where this does not help
Worth knowing before you spend time on it.
- This site cannot tell you a premium. Prices depend on the plans available in your specific area, and we have no rate data.
- Nothing here is an eligibility determination. Only the Marketplace decides that, from your full application.
- If your income falls below the range premium tax credits cover, what is available depends heavily on whether your state expanded Medicaid — a state-by-state question this site cannot answer for you.
- If you are 65 or older, Medicare is usually the better starting point than a Marketplace plan.
- We do not sell or recommend a specific plan, and no plan or carrier is named anywhere on this site.
Common questions
- Can I be turned down for a health condition?
- No. Marketplace plans cannot refuse you, charge you more, or exclude a condition because of your health history. That applies during Open Enrolment and during any Special Enrolment Period you qualify for.
- What if my income turns out to be different from my estimate?
- The credit is reconciled on your tax return. If you earned more than you estimated you may have to repay part of it; if you earned less you may get more back. Telling the Marketplace when your income changes during the year is what keeps that adjustment small.
- Do I have to buy through the Marketplace to get coverage?
- No — you can buy an individual plan directly from an insurer. But premium tax credits are only available on Marketplace plans, so buying outside it means paying the full price yourself.
- Is a plan sold outside the Marketplace the same thing?
- Not necessarily. Some products marketed as health coverage — short-term plans, for instance — are not required to meet the same rules on pre-existing conditions or essential health benefits. Check what a plan actually covers before comparing it on price.
- What does it cost to talk to someone here?
- Nothing. Asking a question through this site is free and carries no obligation to buy anything.
Where this comes from
This page is educational. It is not an eligibility determination, an application, an offer of coverage, or advice.
Eligibility for Marketplace coverage, Medicaid and any premium tax credit is determined by the Health Insurance Marketplace based on your full application.
This site is not affiliated with, or endorsed by, HealthCare.gov, the Centers for Medicare & Medicaid Services, or any government agency.