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ACA Marketplace basics: how buying your own health insurance works

Last reviewed: Published: 7 min read
Quick answer

The Health Insurance Marketplace (created by the Affordable Care Act) is where you can compare and buy individual and family health plans and find out if you qualify for savings. Most states use HealthCare.gov; some run their own Marketplace. Every Marketplace plan covers the same 10 essential health benefits and can't turn you down or charge you more for a pre-existing condition. You can enroll during Open Enrollment or after a qualifying life event.

Who uses the Marketplace

The Marketplace is mainly for people who don't get affordable coverage through a job, Medicare, Medicaid or CHIP: for example the self-employed, early retirees, gig workers, people between jobs and employees whose employer doesn't offer coverage. When you apply, you'll also learn if anyone in your household qualifies for Medicaid or CHIP, which you can apply for at any time of year.

HealthCare.gov or a state Marketplace?

Many states use the federal platform at HealthCare.gov. Others operate their own Marketplace website with its own deadlines. If you go to HealthCare.gov and enter your ZIP code, it will send you to your state's site if your state runs its own.

Watch out for look-alike sites. State insurance regulators warn that some sites that look official are lead generators that collect your information and pass it to insurance marketers. HealthCare.gov and your state's official Marketplace end in .gov or are linked from HealthCare.gov. (PlanCost is an independent educational site; we're not a Marketplace and we don't collect quote requests.)

What every Marketplace plan covers

All Marketplace plans must cover 10 essential health benefits: outpatient care, emergency services, hospitalization, pregnancy/maternity/newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services, lab services, preventive and wellness services (including chronic disease management), and pediatric services including dental and vision care for children.

Pre-existing conditions

Marketplace plans can't refuse to cover you, or charge you more, because of a pre-existing health condition, and they can't refuse to cover treatment for that condition once your coverage starts.

How premiums are set

Under the ACA, insurers can set Marketplace premiums based on only a few factors: your age, where you live, tobacco use, whether the plan covers just you or your family, and the plan category you choose. Health status and gender can't be used.

Savings you might qualify for

  • Premium tax credits lower your monthly premium based on your expected income. For 2027, they're available to households with income between 100% and 400% of the federal poverty level. See our premium tax credit guide.
  • Cost-sharing reductions lower deductibles and copays for eligible incomes, on Silver plans only.

What to have ready before you apply

  • Social Security numbers (or immigration document details) for everyone applying
  • Your best estimate of household income for the coverage year
  • Employer coverage information, if anyone in the household is offered a job-based plan or HRA
  • Your doctors, hospitals and prescriptions, to check plan networks and drug lists
  • Current policy numbers, if you have coverage now

Free help is available

Trained assisters (Navigators) give free, unbiased help. Marketplace-registered agents and brokers can also help you enroll and are paid by insurers, not by you. Find both at localhelp.healthcare.gov.

Frequently asked questions

Is HealthCare.gov the only Marketplace?

No. Many states use HealthCare.gov, but some states run their own Marketplace websites. HealthCare.gov will direct you to your state's site based on your ZIP code.

Can I be denied coverage for a pre-existing condition?

No. Marketplace plans can't refuse to cover you or charge you more because of a pre-existing condition.

What factors affect my Marketplace premium?

Insurers can use your age, location, tobacco use, whether the plan covers individuals or families, and the plan category. Your health history can't be used.

Can I buy a Marketplace plan any time?

Generally only during Open Enrollment, unless you have a qualifying life event that gives you a Special Enrollment Period. Medicaid and CHIP applications are accepted year-round.

Is help with enrolling free?

Yes. Marketplace assisters (Navigators) are free, and agents and brokers are paid by insurance companies, so you don't pay them directly.

Sources

  1. HealthCare.gov: When can you get health insurance? (dates and deadlines) (accessed October 28, 2026)
  2. HealthCare.gov: What Marketplace health insurance plans cover (accessed October 28, 2026)
  3. HealthCare.gov: Coverage for pre-existing conditions (accessed October 28, 2026)
  4. HealthCare.gov: How insurance companies set health premiums (accessed October 28, 2026)
  5. HealthCare.gov: Saving money on health insurance (accessed October 28, 2026)
  6. KFF: Explaining Health Care Reform: Questions About Health Insurance Subsidies (accessed October 28, 2026)
  7. HealthCare.gov: Find local help (assisters, agents and brokers) (accessed October 28, 2026)
Written by the PlanCost editorial team. Reviewed by [EDITOR NAME / BIO].
We check every figure against official sources such as HealthCare.gov, Medicare.gov, CMS, the IRS and the U.S. Department of Labor, and link them below. PlanCost is not an insurance agent; this is general information, not personal advice. How we research and update guides.

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