Marketplace plans, in plain English
ACA Marketplace plans are individual and family health plans sold through the federal Health Insurance Marketplace. Every Marketplace plan covers a standard set of essential health benefits, including doctor visits, emergency care, hospital stays, prescriptions, maternity care, mental health care and preventive care. Plans cannot turn you down or charge you more because of a pre-existing condition.
Metal tiers: how costs are split
Plans are grouped into metal tiers. The tier tells you how you and the plan share costs, not how good the care is.
| Tier | Monthly premium | Costs when you get care |
|---|---|---|
| Bronze | Lowest | Highest |
| Silver | Moderate | Moderate, and lower if you qualify for extra savings |
| Gold | Higher | Lower |
| Platinum | Highest | Lowest |
Catastrophic plans are also available to people under 30 and some people with a hardship exemption. They have low premiums and very high deductibles.
What would you actually pay?
Drag the bill and watch how the cost is split between you and the plan. This is how Davis explains deductibles and out-of-pocket maximums before you choose.
Example plans for illustration only, not quotes. Real plans vary, and premiums and copays aren't shown.
Income-based savings
Depending on your expected household income for the year, you may qualify for a premium tax credit that lowers your monthly premium. If your income is in a lower range and you choose a Silver plan, you may also qualify for cost-sharing reductions, which lower your deductible and copays.
HMO, EPO or PPO?
The network type decides which doctors you can see and whether you need referrals. HMO and EPO plans usually cost less but limit you to their network. PPO plans cost more but let you see doctors outside the network for a higher price. Davis checks your doctors against each plan before you choose.
Private plans outside the Marketplace
Some people compare Marketplace plans with plans sold outside it. Rules, coverage and eligibility can differ, so Davis walks you through what each option does and doesn't include before you decide.
Common questions
Can I be denied for a pre-existing condition?
Not on a Marketplace plan. ACA Marketplace plans cannot refuse coverage or charge more because of a pre-existing condition.
Does it cost more to enroll through a broker?
For Marketplace plans, the premium is the same whether you enroll on your own or with a licensed agent like Davis.
What if I lose my job mid-year?
Losing other health coverage is a qualifying life event. It usually opens a Special Enrollment Period so you can enroll in a Marketplace plan.
