ACA Marketplace health plans

What ACA Marketplace coverage includes

Every Marketplace plan has to cover a core set of benefits, no matter which carrier you choose:

• Doctor visits, specialists and preventive care
• Emergency services and hospitalization
• Prescription drugs
• Laboratory tests and diagnostic services
• Maternity and newborn care
• Mental health and substance use treatment
• Rehabilitative services and devices
• Pediatric services, including children's dental and vision

Two protections matter more than people realize. You cannot be turned down or charged more because of a pre-existing condition — not diabetes, not cancer history, not pregnancy. And in-network preventive care, things like annual checkups, screenings and routine immunizations, is covered without a copay.

Adult dental and vision are generally not part of a medical plan. If you want those, they're separate policies, and we can quote them alongside your health coverage.

Do I qualify for help paying for it?

Many people do, and most underestimate it.

Financial help on the Marketplace works in two ways. A premium tax credit lowers what you pay each month. Separately, extra cost-sharing savings can lower your deductible and copays — but those are only available on Silver-level plans, which is why the cheapest plan on the list isn't always the cheapest plan for you.

What you qualify for depends on your expected household income for the coming year, how many people are in your household, where you live, and the rules in effect for that plan year. There's no way to know from a general article — it has to be run for your specific situation, and that's a free, no-obligation conversation with us.

One thing worth knowing: you estimate next year's income, not last year's. If you're self-employed or your income moves around, this is where most people get it wrong.

Bronze, Silver, Gold — which one?

The metal level isn't about quality of care. Every plan covers the same core benefits. The difference is how the cost is split between what you pay monthly and what you pay when you actually use care.

Bronze has the lowest monthly premium and the highest out-of-pocket costs. It suits someone healthy, with savings to absorb a bad year.

Silver sits in the middle — and matters most if your income qualifies you for cost-sharing savings, since those only apply here.

Gold and Platinum cost more each month but far less when you use care. They make sense if you see doctors regularly, take ongoing prescriptions, or have a procedure coming.

There's no universally right answer. The right plan depends on your doctors, your prescriptions, your budget and how much risk you can carry.

Who this is for

Marketplace coverage is built for people without access to affordable employer insurance:

• Self-employed people, 1099 contractors and freelancers
• Small business owners and their families
• Anyone between jobs or who just lost employer coverage
• Early retirees not yet eligible for Medicare
• Families whose employer plan doesn't cover dependents affordably
• Anyone whose income changes month to month

When you can enroll

Open Enrollment is your once-a-year window. For 2027 coverage it runs November 1, 2026 through January 15, 2027 in most states.

Two dates matter, and they do different things. Enroll by December 15 and your coverage starts January 1. Enroll between December 16 and January 15 and it starts February 1. Miss January 15 and you generally wait a full year.

A handful of states run their own exchange with a different calendar — Colorado is one of them — so we'll confirm your exact deadline for your state before you plan around it.

Outside that window, you can still enroll if you have a qualifying life event: losing job-based coverage, moving to a new state, getting married or divorced, having or adopting a child, or aging off a parent's plan. That opens a Special Enrollment Period, usually 60 days from the event. Medicaid and CHIP have no window at all — you can apply any time if you qualify.

How we help

We compare the whole market available in your state — not one company's lineup.

We get your income estimate right, which is the single most common and most expensive mistake people make on their own.

We check your doctors, your hospitals and your prescriptions against each plan before you enroll, because networks change every year, even on the same plan you had last year.

And we're here after you enroll. Claim denied, doctor dropped from the network, income changed mid-year — you call us, not a 1-800 line. That's the part most people don't realize they're giving up by enrolling alone.

Our guidance costs you nothing. Carriers pay our commission, and it's already built into the plan's price, which is set by the carrier and regulated by law. You pay the same premium either way. You just stop doing it alone.

What to have ready

• Names, birthdates and Social Security numbers for everyone on the plan
• Your best estimate of next year's household income
• Your current plan details, if you have one
• A list of your doctors and prescriptions, so we can check the networks