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What is a Health Insurance Marketplace?

This year the enrollment period is shorter than in previous years, so it’s important to act quickly. If you don’t act by December 15, you can’t get 2018 coverage unless you qualify for a Special Enrollment Period. Plans sold during Open Enrollment start January 1, 2018.

Every health insurance option in the Marketplace will offer comprehensive coverage, from doctors to medications to hospital visits. You can compare all your insurance options based on:

  • price,
  • benefits,
  • quality, and
  • other features that may be important to you.

Insurance coverage run by private companies

When you shop at the Marketplace, coverage information will be laid out for you. All your costs are stated up front, so you’ll get a clear picture of what you pay and what coverage you receive before you make a choice. Health insurance companies can't refuse to cover you or charge you more just because you have a chronic or pre-existing condition, and they can’t charge more for women than for men.

You may save on your monthly premiums

When you apply for coverage in the Health Insurance Marketplace, you’ll find out if you qualify for a premium tax credit to help lower your premium, which is the amount you pay each month to your insurance plan. The amount of your premium tax credit depends on the estimated household income for 2018 that you put on your Marketplace application.

Find out if your estimated 2018 income is in the range to qualify for a premium tax credit.

Coverage falls into four categories

The category you choose affects how much your premium costs each month and what portion of the bill you pay for things like hospital visits or prescription medications. It also affects your out-of-pocket costs —the total amount you’ll spend for the year if you need care. The categories are

  • Bronze
  • Silver
  • Gold
  • Platinum

The Marketplace also offers "catastrophic" policies to people under 30 years old and to some people with very low incomes.

Balancing monthly premiums with out-of-pocket costs

As with all health coverage, you will still have to pay a monthly premium.

  • Premiums are usually higher for policies that pay more of your out-of-pocket medical costs when you get care. For example, if you have a Gold policy, you'll likely pay a higher premium, but may have lower costs when you go to the doctor or use another medical service.
  • With a Bronze policy, you'll likely pay a lower premium, but you'll pay a higher share of costs when you get care.
  • Platinum policy will likely have the highest monthly premiums and lowest out-of-pocket costs.

The policy will pay more of the costs if you need a lot of medical care.

In general, when choosing your health coverage, keep this in mind:

  • the lower the premium, the higher the out-of-pocket costs when you need care;
  • the higher the premium, the lower the out-of-pocket costs when you need care.