Health Insurance Marketplace Guide: ACA Enrollment for 2026

The Health Insurance Marketplace, created by the Affordable Care Act (ACA) and commonly known as Obamacare, is the primary way approximately 21 million Americans purchase individual health insurance coverage. Whether you are self-employed, between jobs, a freelancer, an early retiree, or simply do not have access to affordable employer-sponsored insurance, the marketplace provides a structured way to compare plans, apply for financial assistance, and enroll in ACA-compliant health coverage.

Despite serving millions of people, the marketplace remains confusing for many consumers. A 2025 Kaiser Family Foundation survey found that 42% of uninsured adults who were eligible for marketplace subsidies did not know they qualified for financial help, and 35% of marketplace enrollees said they found the plan selection process "difficult" or "very difficult." These knowledge gaps cost Americans real money — choosing the wrong metal tier, missing cost-sharing reductions, or failing to report income changes can mean paying hundreds or thousands of dollars more than necessary each year.

This guide explains every aspect of marketplace enrollment in plain, practical language. We cover the enrollment timeline, how the four metal tiers actually work, how to calculate your premium tax credits and cost-sharing reductions, the step-by-step enrollment process, and the most costly mistakes to avoid. Every data point reflects 2026 plan year figures.

What Is the Health Insurance Marketplace?

The Health Insurance Marketplace is a government-operated platform where individuals and families can shop for, compare, and purchase health insurance plans that meet ACA standards. The federal marketplace at Healthcare.gov serves residents of 35 states, while 15 states plus the District of Columbia operate their own state-based exchanges with separate websites and enrollment systems.

Every plan sold on the marketplace must comply with ACA requirements, meaning all plans must:

• Cover 10 essential health benefits: ambulatory services, emergency care, hospitalization, maternity and newborn care, mental health and substance use services, prescription drugs, rehabilitative services, laboratory work, preventive care, and pediatric services (including dental and vision for children)
• Accept all applicants regardless of pre-existing conditions: no insurer can deny coverage, charge higher premiums, or exclude treatment based on your health history, including chronic conditions like diabetes, cancer, or sickle cell disease
• Cover preventive services at no cost: annual checkups, vaccinations, cancer screenings, blood pressure checks, and other preventive care must be provided with $0 cost-sharing when you use in-network providers
• Cap annual out-of-pocket costs: the maximum out-of-pocket limit for 2026 is $9,200 for individual plans and $18,400 for family plans. Once you reach this cap, the plan pays 100% of covered services for the remainder of the year
• Eliminate annual and lifetime benefit caps: no dollar limit on how much the plan will pay for your covered care in a given year or over your lifetime

The marketplace also serves as the gateway to financial assistance. When you apply, the system evaluates your household income against the federal poverty level to determine whether you qualify for Medicaid (if your state has expanded), premium tax credits, cost-sharing reductions, or the Children's Health Insurance Program (CHIP) for your dependents. This integrated eligibility determination is one of the most valuable features of the marketplace — a single application connects you to all available programs.

Open Enrollment Period: Dates and Deadlines

Open Enrollment is the annual window during which anyone can sign up for a new marketplace plan, switch plans, or renew their existing coverage. For the 2026 plan year:

• Open Enrollment start date: November 1, 2025
• Deadline for January 1 coverage: December 15, 2025 — if you want your new plan to take effect on the first day of the new year, you must complete enrollment by this date
• Open Enrollment end date: January 15, 2026 — this is the final deadline to enroll in a 2026 marketplace plan. Plans selected between December 16 and January 15 have a February 1 effective date

These dates apply to the federal marketplace (Healthcare.gov). State-based exchanges may have different deadlines — some extend enrollment beyond January 15, while others align with the federal timeline. Check your state exchange's website for specific dates if you live in a state that operates its own marketplace.

If you are already enrolled in a marketplace plan and take no action during Open Enrollment, you will typically be auto-renewed into the same plan (or a similar plan if yours is discontinued) for the upcoming year. However, auto-renewal is almost always a financial mistake because premiums, deductibles, networks, and formularies change annually. The plan that was your best option last year may be $50-$150/month more expensive this year, or it may have dropped your preferred doctors from its network. Actively shopping and comparing plans during Open Enrollment takes 30-60 minutes and regularly saves consumers $500-$2,000+ per year.

Special Enrollment Periods and Qualifying Life Events

Outside of the annual Open Enrollment window, you can only enroll in a marketplace plan through a Special Enrollment Period (SEP), which is triggered by a qualifying life event. The most common qualifying events are:

• Loss of existing coverage: losing employer-sponsored insurance (due to job loss, layoff, hours reduction, or employer discontinuing coverage), losing Medicaid or CHIP eligibility, aging off a parent's plan at 26, COBRA coverage expiring, or losing student health coverage upon graduation
• Moving to a new area: relocating to a different ZIP code, county, or state where different marketplace plans are available. This includes moving within a state if the move changes your marketplace plan options
• Changes in household composition: getting married, getting divorced, having a baby, adopting a child, or placing a child for foster care. A new marriage or new dependent triggers a 60-day SEP
• Income changes affecting eligibility: household income dropping below or rising above Medicaid thresholds, or changes that significantly alter your subsidy eligibility
• Gaining citizenship or immigration status: becoming a U.S. citizen, U.S. national, or lawfully present immigrant
• Leaving incarceration: being released from jail or prison
• Other qualifying events: losing eligibility for TRICARE or Peace Corps coverage, experiencing a natural disaster that disrupts your plan, or having a marketplace plan violation by your insurer

Most SEPs provide a 60-day window from the date of the qualifying event to select a new plan. Coverage typically begins on the first of the month following plan selection, though some events (like birth or adoption) allow retroactive coverage to the date of the event. You will need to provide documentation of your qualifying event — for example, a termination letter from your employer, a marriage certificate, or a lease agreement for a new address.

One important note: voluntarily dropping your health insurance does not qualify as a life event. If you cancel your plan or simply stop paying premiums, you will not receive an SEP and must wait until the next Open Enrollment to re-enroll. The exception is if your plan was terminated by the insurer or by the marketplace due to a processing error — in those cases, you may qualify for an SEP.

Metal Tiers Explained: Bronze, Silver, Gold, and Platinum

ACA marketplace plans are organized into four metal tiers that represent how costs are shared between you and the insurance company. All tiers cover the same essential health benefits — the only difference is the cost-sharing structure. Here is what each tier looks like for a 40-year-old individual in 2026:

Actuarial value is the key concept. It represents the percentage of total average healthcare costs the plan pays across its entire membership pool. A Bronze plan with 60% actuarial value means the insurer covers approximately 60% of the cost of covered services on average, while you cover approximately 40% through your deductible, copays, and coinsurance. Critically, this is an average across all members — your personal cost share depends on how much care you use.

Bronze plans are designed for people who want the lowest monthly premium and are willing to accept high out-of-pocket costs if they need care. With deductibles of $7,000-$7,500, you pay the full cost of most medical services until you hit that threshold. Preventive care (checkups, screenings, vaccinations) is still covered at $0 regardless of deductible. Bronze plans are the rational choice for healthy adults who primarily want catastrophic protection — insurance that keeps a car accident, unexpected surgery, or cancer diagnosis from bankrupting you.

Silver plans are the most popular tier, enrolling approximately 70% of marketplace consumers. There are two reasons for this dominance. First, Silver premiums are moderate — the monthly cost is manageable for middle-income households, especially after premium tax credits. Second, and more importantly, Silver plans are the only tier eligible for cost-sharing reductions (CSR), which dramatically lower deductibles and out-of-pocket maximums for consumers earning below 250% of the federal poverty level. A Silver plan with CSR for a low-income consumer can have an effective actuarial value of 94% — comparable to an employer-sponsored plan — at a fraction of the Gold or Platinum premium. We explain CSR in detail in the section below.

Gold plans offer a good balance for consumers who use healthcare regularly but do not qualify for Silver plan CSR. With deductibles of $1,500-$2,500 and out-of-pocket maximums of $7,500-$8,500, Gold plans provide more predictable costs throughout the year. You pay more monthly but face lower per-visit charges. Gold plans are particularly valuable for people who take multiple prescription medications, see specialists regularly, or expect a hospitalization or surgery during the plan year.

Platinum plans provide the most comprehensive coverage with near-zero deductibles and the lowest out-of-pocket maximums ($2,500-$4,000). The trade-off is the highest monthly premiums — $700-$900/month for a 40-year-old before subsidies. Platinum plans are rare on many state marketplaces, with fewer carriers offering them. They are the best financial choice for consumers who know they will exceed $15,000+ in annual healthcare costs, as the total annual spending (premiums + OOP) is capped at the lowest level.

There is also a fifth category: Catastrophic plans, available only to adults under 30 or those with a hardship/affordability exemption. Catastrophic plans cover three primary care visits per year before the deductible (plus required preventive care at $0), with premiums as low as $150-$250/month. However, the deductible equals the full out-of-pocket maximum ($9,200 in 2026), meaning you pay for virtually all care out of pocket until a medical catastrophe hits. Catastrophic plans are not eligible for premium tax credits.

Premium Tax Credits: How to Calculate Your Subsidy

Premium tax credits (PTCs) are the federal government's primary tool for making marketplace health insurance affordable. These credits reduce your monthly premium, and their value depends on your household income relative to the federal poverty level (FPL). Here are the 2026 FPL thresholds for the 48 contiguous states (Alaska and Hawaii have higher thresholds):

How the credit is calculated: The premium tax credit equals the cost of the benchmark Silver plan in your area (the second-lowest-cost Silver plan) minus your expected contribution based on income. Under the enhanced subsidies extended from the American Rescue Plan, no household pays more than 8.5% of income toward the benchmark Silver plan. The income-based contribution percentages for 2026 are approximately:

• Up to 150% FPL: 0-2% of income (many people pay $0-$25/month)
• 150-200% FPL: 2-4% of income
• 200-250% FPL: 4-6% of income
• 250-300% FPL: 6-7.5% of income
• 300-400% FPL: 7.5-8.5% of income
• Above 400% FPL: 8.5% of income (enhanced subsidy; without ARP extension, no subsidy above 400%)

Example calculation: A 40-year-old individual in Atlanta earning $35,000/year (approximately 232% FPL). The benchmark Silver plan in Atlanta costs $540/month. At 232% FPL, the expected contribution is approximately 5.2% of income = $35,000 x 0.052 / 12 = $152/month. The premium tax credit is $540 - $152 = $388/month. This credit can be applied to any metal tier plan — if you choose a Bronze plan at $320/month, the credit makes it effectively free ($320 - $388 = -$68, capped at $0). If you choose a Gold plan at $650/month, you pay $650 - $388 = $262/month.

You can take the premium tax credit in one of two ways: as an advance payment (applied monthly to reduce your premium bill) or as a lump-sum credit when you file your annual tax return. Most consumers choose the advance option for immediate cash flow relief. However, if your actual annual income differs from the estimate you provided at enrollment, you will need to reconcile the credit on your tax return — which can result in owing money back to the IRS if you earned more than estimated, or receiving an additional refund if you earned less.

Cost-Sharing Reductions on Silver Plans

Cost-sharing reductions (CSR) are one of the most valuable — and least understood — benefits of the ACA marketplace. CSR lowers your deductible, copays, coinsurance, and out-of-pocket maximum on Silver plans only. They are available to households earning between 100% and 250% of the federal poverty level and are applied automatically when you select a Silver plan.

CSR works by increasing the actuarial value of your Silver plan based on your income level:

The impact is dramatic. A consumer earning 130% FPL ($19,578 for an individual) who selects a Silver plan receives a CSR-enhanced version with 94% actuarial value — equivalent to a top-tier employer plan. Their deductible drops from $5,000+ to as little as $75, and their out-of-pocket maximum falls from $9,200 to approximately $1,300. Copays for doctor visits might be $5-$10 instead of $40-$60, and generic prescriptions might cost $3 instead of $15-$25.

This is why financial advisors consistently recommend Silver plans for consumers earning below 250% FPL, even when a Bronze plan has a lower monthly premium. The cost-sharing reductions on Silver plans provide so much value in reduced deductibles and copays that the slightly higher monthly premium is more than offset by lower costs when you actually use healthcare services.

CSR is only available on Silver plans — if you choose Bronze, Gold, or Platinum, you receive your premium tax credit but no cost-sharing reductions, regardless of income. This is the single most common mistake marketplace consumers make: choosing a Bronze plan to save on premiums without realizing they are forfeiting thousands of dollars in CSR benefits by not selecting Silver.

Step-by-Step Marketplace Enrollment Process

Enrolling in a marketplace plan through Healthcare.gov (or your state exchange) follows these steps. The entire process takes 45-90 minutes if you have your documents ready:

Step 1: Gather your documents. Before starting, collect the following for each household member who needs coverage:

• Social Security numbers (or document numbers for legal immigrants)
• Most recent tax return (for income verification)
• Pay stubs or income statements for current year income estimate
• Information about any employer-sponsored insurance available to you (including the employer's plan costs)
• Current insurance policy numbers (if switching plans)

Step 2: Create an account at Healthcare.gov (or your state exchange). You will need an email address and will create a username and password. Identity verification requires answering security questions based on your credit history — have your address history and prior car/mortgage information accessible.

Step 3: Complete the application. The application asks for household demographic information (names, dates of birth, citizenship status), income details (projected annual income for the coverage year), and information about employer-sponsored coverage. Answer accurately — income estimates that are significantly off will require reconciliation on your tax return.

Step 4: Review your eligibility determination. Based on your application, the marketplace will determine whether you qualify for Medicaid (if applicable in your state), premium tax credits, cost-sharing reductions, or CHIP for dependents. Review these results carefully — if your income was entered incorrectly, your subsidy amount will be wrong.

Step 5: Browse and compare plans. The marketplace displays all available plans in your area, organized by metal tier. Use the built-in comparison tools to evaluate plans side by side. Key factors to compare: monthly premium after subsidy, annual deductible, out-of-pocket maximum, copays for primary care and specialist visits, prescription drug costs (check the formulary for your medications), and the provider network (verify your doctors are in-network).

Step 6: Select your plan and confirm enrollment. Once you have chosen a plan, review the summary of benefits and costs one final time, then confirm your selection. You will receive a confirmation with your plan details, effective date, and premium payment instructions.

Step 7: Pay your first premium. Your coverage does not begin until you pay the first month's premium. The marketplace will direct you to your insurance company's payment portal. Set up autopay to avoid missing future payments, which can result in your plan being terminated.

Medicaid vs Marketplace: Income Cutoffs by State

The dividing line between Medicaid and marketplace coverage is income. In states that expanded Medicaid under the ACA, adults earning up to 138% of the federal poverty level ($20,783 for an individual, $42,268 for a family of four in 2026) are eligible for Medicaid. Above that threshold, you shop on the marketplace with premium tax credits.

As of 2026, 40 states plus the District of Columbia have expanded Medicaid. The 10 states that have not expanded Medicaid are: Texas, Florida (partial expansion underway), Georgia, Tennessee, Mississippi, Alabama, South Carolina, Wyoming, Wisconsin (covers adults up to 100% FPL through a waiver), and Kansas. In non-expansion states, Medicaid eligibility for non-disabled, non-pregnant adults is extremely limited — often requiring income below 20-40% of the FPL with dependent children.

This creates the "coverage gap" in non-expansion states: adults earning too much for traditional Medicaid (which may be as low as $4,000-$6,000/year) but below 100% FPL ($15,060 for an individual) are ineligible for both Medicaid and marketplace subsidies. An estimated 1.5-2 million Americans fall into this gap. If you are in a non-expansion state, check whether your state has a Medicaid waiver program or other assistance programs that might provide coverage.

When you apply through Healthcare.gov, the system automatically determines whether you qualify for Medicaid or marketplace subsidies based on your reported income. You do not need to apply separately for Medicaid — the marketplace routes your application to your state Medicaid agency if you qualify. One advantage of Medicaid is year-round enrollment — unlike the marketplace, you can apply for and receive Medicaid at any time, with no Open Enrollment restriction.

State-Based Exchanges vs Healthcare.gov

Fifteen states and the District of Columbia operate their own health insurance marketplace exchanges rather than using the federal Healthcare.gov platform. If you live in one of these states, you must use the state exchange to enroll:

• California: Covered California (coveredca.com)
• Colorado: Connect for Health Colorado (connectforhealthco.com)
• Connecticut: Access Health CT (accesshealthct.com)
• District of Columbia: DC Health Link (dchealthlink.com)
• Idaho: Your Health Idaho (yourhealthidaho.org)
• Kentucky: kynect (kynect.ky.gov)
• Maine: CoverME.gov (coverme.gov)
• Maryland: Maryland Health Connection (marylandhealthconnection.gov)
• Massachusetts: Health Connector (mahealthconnector.org)
• Minnesota: MNsure (mnsure.org)
• Nevada: Nevada Health Link (nevadahealthlink.com)
• New Jersey: GetCovered.NJ.gov (getcovered.nj.gov)
• New York: NY State of Health (nystateofhealth.ny.gov)
• Rhode Island: HealthSource RI (healthsourceri.com)
• Vermont: Vermont Health Connect (info.healthconnect.vermont.gov)
• Washington: Washington Healthplanfinder (wahealthplanfinder.org)

State-based exchanges offer the same essential ACA protections and subsidy structures as Healthcare.gov, but some provide additional benefits. For example, several state exchanges have extended Open Enrollment deadlines (Covered California has historically extended enrollment through January 31), and some states offer supplemental state-funded subsidies that reduce premiums beyond what federal credits provide. Massachusetts, for instance, offers ConnectorCare plans that provide additional subsidies for residents earning up to 300% FPL.

The plan options and premiums on state exchanges differ from federal marketplace states because each state negotiates separately with insurance carriers. Consumers in state-exchange states may find different carrier options and price points compared to similar demographic areas in federal marketplace states.

How to Choose the Right Marketplace Plan

With 30-60+ plans available in most areas, choosing the right marketplace plan requires a systematic approach. Follow these steps in order:

1. Start with your income and subsidy eligibility. Run the numbers on Healthcare.gov's subsidy calculator before browsing plans. Knowing your premium tax credit and CSR eligibility narrows your options immediately. If you qualify for CSR (below 250% FPL), a Silver plan is almost always your best choice — skip directly to comparing Silver plans.

2. Estimate your healthcare usage for the coming year. Think honestly about how much care you expect to use. Will you have mostly preventive visits? Do you take regular medications? Are you planning a surgery or expecting a baby? Do you manage a chronic condition? Your expected utilization determines whether you should prioritize low premiums (Bronze) or low cost-sharing (Gold/Platinum). For help comparing specific insurance carriers, see our guide to the best health insurance companies.

3. Check that your doctors and hospitals are in-network. Before committing to any plan, look up your primary care physician, specialists, and preferred hospitals in the plan's provider directory. Marketplace plans, especially HMO and EPO structures, often have narrower networks than employer plans. An out-of-network specialist visit can cost $300-$500+ compared to a $40-$60 in-network copay.

4. Review the prescription drug formulary. If you take medications, check each drug on the plan's formulary. Pay attention to which tier your drugs are placed on (Tier 1 generics are cheapest; Tier 4-5 specialty drugs can cost $100-$500+ per fill). Also check for step therapy requirements (being required to try a cheaper drug before the plan covers your prescribed medication) and prior authorization requirements.

5. Calculate total annual cost, not just monthly premium. The cheapest monthly premium is rarely the cheapest total annual cost. Add up: (12 months of premiums) + (expected deductible spending) + (estimated copays and coinsurance) = total annual cost. A Gold plan at $650/month with a $2,000 deductible totals $9,800 in premiums + $2,000 in deductible spending = $11,800 maximum if you are a high-utilization patient. A Bronze plan at $330/month with a $7,500 deductible totals $3,960 + $7,500 = $11,460 maximum. The difference is minimal, but the Gold plan provides much better day-to-day cost predictability and coverage from the first dollar after a modest deductible.

6. Consider the out-of-pocket maximum as your worst-case scenario. The OOP max represents the most you will pay in a year if something catastrophic happens. For people with any meaningful health risk, this number matters enormously. A plan with a $6,500 OOP max limits your downside far more effectively than one with a $9,200 OOP max — a $2,700 difference that could be critical during a medical crisis.

Common Mistakes to Avoid

After analyzing marketplace enrollment data and consumer complaints, these are the most costly and frequent mistakes people make when buying health insurance through the marketplace:

1. Not enrolling in a Silver plan when eligible for CSR. This is the single most expensive mistake. A consumer earning 140% FPL who chooses a Bronze plan to save $80/month on premiums forfeits a Silver CSR plan with a $250 deductible and $1,300 OOP max. If they need even moderate healthcare, the Bronze plan's $7,500 deductible will cost them thousands more than the Silver plan's slightly higher premium. Every consumer earning below 250% FPL should seriously evaluate Silver plans before any other tier.

2. Auto-renewing without shopping. Marketplace premiums change every year, sometimes dramatically. Carriers enter and exit markets, plan designs are modified, and the benchmark Silver plan (which determines your subsidy amount) may shift to a different carrier. A 2024 CMS analysis found that consumers who actively shopped during Open Enrollment saved an average of $600/year compared to those who auto-renewed. Spending 30-60 minutes comparing plans annually is one of the highest-return activities in personal finance.

3. Underestimating or overestimating income. Your premium tax credit is based on projected annual income. If you significantly underestimate your income, you will receive a larger advance credit than you are entitled to — and must repay the excess when you file your tax return (up to $2,975 for individuals and $5,950 for families at certain income levels). If you overestimate income, you receive a smaller credit than deserved and get the difference as a tax refund, but you overpay throughout the year. Report income changes to the marketplace as they occur to keep your credit aligned with reality.

4. Ignoring the provider network. Approximately 30% of marketplace consumer complaints relate to provider network issues — enrolling in a plan only to discover that a preferred doctor is out-of-network, or finding that the nearest in-network hospital is 45+ minutes away. Always verify network status by calling both the insurance company and the provider's office directly. Online provider directories are frequently outdated.

5. Forgetting to pay the first premium. Your marketplace enrollment is not complete until you pay the first month's premium to your insurance company. The marketplace sends your enrollment information to the carrier, but you must initiate payment yourself — typically through the carrier's website or by calling their billing department. Failing to pay within the deadline (usually 30 days after plan selection) cancels your enrollment entirely. Set a calendar reminder and confirm payment receipt.

6. Not reporting life changes. Marriage, divorce, a new baby, job loss, a significant income change, or a move to a new state all affect your marketplace eligibility and subsidy amount. Failing to report these changes means your premium tax credit may be wrong, resulting in a large reconciliation adjustment on your tax return. Report changes at Healthcare.gov or your state exchange within 30 days.

7. Choosing based on premium alone. The lowest-premium plan is often the most expensive overall for anyone who actually uses healthcare. A $280/month Bronze plan with a $7,500 deductible and $9,200 OOP max is only a good deal if you stay healthy all year. One ER visit ($2,000-$5,000 average), one specialist workup ($1,000-$3,000), or one chronic condition diagnosis can push your total spending well above what a more comprehensive plan would have cost. Evaluate total annual cost scenarios, not just the monthly premium sticker price.

For more on managing healthcare costs whether insured or uninsured, see our healthcare costs resource center.

Frequently Asked Questions About the Health Insurance Marketplace

When is open enrollment for health insurance in 2026?

Open enrollment for 2026 ACA marketplace health insurance runs from November 1, 2025 through January 15, 2026 on Healthcare.gov and most state-based exchanges. If you enroll by December 15, your coverage starts January 1. If you enroll between December 16 and January 15, your coverage starts February 1. Some state-based exchanges (like California's Covered California and New York's NY State of Health) may have slightly different deadlines. Outside of open enrollment, you can only enroll through a Special Enrollment Period triggered by a qualifying life event.

How much are premium tax credits for marketplace health insurance?

Premium tax credit amounts depend on your household income relative to the federal poverty level (FPL). Under the enhanced subsidies extended through 2025, no one pays more than 8.5% of household income toward a benchmark Silver plan premium. A 40-year-old individual earning $30,000/year (about 200% FPL) may receive approximately $350-$450/month in tax credits. A family of four earning $60,000/year (about 194% FPL) may receive $800-$1,200/month. Credits are calculated as the difference between the benchmark Silver plan premium in your area and your expected contribution based on income. You can take credits in advance to lower monthly premiums or claim them when filing your tax return.

What is the difference between Bronze, Silver, Gold, and Platinum health insurance plans?

The four metal tiers differ in how costs are shared between you and the insurer. Bronze plans cover 60% of average costs (you pay 40%) with the lowest premiums ($310-$350/month) but highest deductibles ($7,000-$7,500). Silver plans cover 70% with moderate premiums ($450-$550/month) and are the only tier eligible for cost-sharing reductions. Gold plans cover 80% with higher premiums ($550-$700/month) but lower deductibles ($1,500-$2,500). Platinum plans cover 90% with the highest premiums ($700-$900/month) but lowest out-of-pocket costs. All tiers cover the same essential health benefits — the difference is only in cost-sharing.

What is a Special Enrollment Period and how do I qualify?

A Special Enrollment Period (SEP) allows you to enroll in or change marketplace health insurance outside of the annual open enrollment window. You qualify for an SEP by experiencing a qualifying life event, including: losing existing health coverage (job loss, aging off parent's plan, COBRA expiring), moving to a new ZIP code or county, getting married or divorced, having a baby or adopting a child, changes in household income that affect subsidy eligibility, or becoming a U.S. citizen. Most SEPs give you 60 days from the qualifying event to select a new plan. You must provide documentation of the qualifying event when applying.

Should I choose a marketplace plan or Medicaid?

You do not choose between them — your income determines which program you qualify for. In the 40 Medicaid expansion states (plus D.C.), adults earning up to 138% of the federal poverty level ($20,783 for an individual, $42,268 for a family of four in 2026) are eligible for Medicaid, which provides comprehensive coverage with little to no cost-sharing. If your income exceeds Medicaid limits, you shop on the marketplace and may qualify for premium tax credits (up to 400% FPL) and cost-sharing reductions (up to 250% FPL on Silver plans). When you apply at Healthcare.gov, the system automatically determines whether you qualify for Medicaid or marketplace subsidies based on your income.