Individual and family
ACA Marketplace
On-exchange individual and family plans with advance premium tax credits, plus the off-exchange options that sometimes price better.
- Who it suits
- Individuals
- Carriers shopped
- The whole panel
- Cost to you
- $0
Overview
What this line actually does
The Marketplace is where most people without employer coverage and under 65 buy. Plans are sold in metal tiers, all cover the same ten essential health benefits, and the differences between tiers are cost sharing and network rather than what is covered.
The number that matters is your estimated household modified adjusted gross income for the coverage year, because that sets your advance premium tax credit. Estimate high and you leave money on the table each month. Estimate low and you reconcile the difference on your tax return. We would rather you got it close.
Cost-sharing reductions are worth knowing about too: at lower income levels a Silver plan quietly becomes much richer than its metal tier suggests, which is why Silver is often the right answer even when Bronze looks cheaper.
How it works
From first call to in force
Estimate income
Household MAGI for the coverage year, including self-employment and any spousal income.
Set household size
Everyone on the tax return, which is not always everyone in the house.
Compare tiers
Bronze, Silver, Gold and their real cost sharing after any cost-sharing reduction.
Check the network
Marketplace networks are narrower than group networks. We verify your providers.
Enroll and monitor
Open Enrollment or a qualifying event, then a mid-year check if your income moves.
What moves the number
Cost factors
| Factor | Why it matters |
|---|---|
| Household income | Advance premium tax credits scale with income relative to the federal poverty level for your household size. |
| Household size | Tax dependents count. A college student you claim changes the calculation. |
| Metal tier | Bronze trades a low premium for high cost sharing. Gold does the reverse. Silver carries the cost-sharing reductions. |
| Age and ZIP | Premiums are age-banded and rated by county, with no medical underwriting. |
| Tobacco use | Carriers may apply a tobacco surcharge, which is not offset by the premium tax credit. |
Scroll the table sideways to see every column.
Related lines
Often looked at alongside this
Before you decide
Marketplace questions we hear most
If your question is not here, call the desk. Nobody will put you on a list for asking.
No. Marketplace carriers pay a commission and the rate you pay is the same whether you enroll through us, through Healthcare.gov directly, or through anyone else. Our help costs you nothing.
Report it. Your advance premium tax credit adjusts going forward, which prevents a reconciliation bill at tax time. This is the most common mistake we see in 1099 households.
Only with a qualifying life event such as losing other coverage, moving, marrying, or having a child. Most Special Enrollment Periods run 60 days from the event.
No. They are separate programs with separate eligibility. If your household income falls into the Medicaid range in Ohio, we will tell you and point you to the right application.
Bring us the file. We will bring the market.
Send a census or ask one question. Either way it costs you nothing and nobody will chase you.
Independent and multi-carrier. $0 cost to work with us. No pressure scripts.