Individual (ACA) Plans

Understanding Marketplace Coverage

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Explore the topics below to learn how ACA coverage works, from eligibility and enrollment to costs and metal levels.

Who is eligible?

Individual ACA coverage is designed for individuals and families who need to purchase health insurance on their own. It may be an option if you’re self-employed, between jobs, losing employer coverage, aging off a parent’s plan, retiring before Medicare eligibility, or looking for individual or family coverage.

When can I enroll?

You can enroll during the annual Open Enrollment Period. Certain life changes, such as losing coverage, getting married, having a baby, or moving, may also qualify you for a Special Enrollment Period.

What do I need to get started?

To enroll, you generally must live in the United States, be a U.S. citizen or national or be lawfully present, and not be incarcerated. Eligibility and available savings are determined when you apply.

What is a premium?

Your premium is what you pay each month to have health coverage. It’s only one part of your plan’s total cost.

What is a deductible?

Your deductible is the amount you may pay for covered healthcare services before your plan begins sharing certain costs.

Are there other costs?

Yes. You may also have copays or coinsurance when you receive care. Your out-of-pocket maximum limits how much you pay for covered, in-network care during the year.

What does each plan cover?

Metal levels describe how you and your health plan generally share healthcare costs. They do not represent the quality of your plan or the care you receive.

Compare metal levels

Bronze: Lower monthly premiums with higher costs when you use care.
Silver: A balance between monthly premiums and out-of-pocket costs. If you qualify for additional cost-sharing savings, those savings are available only with a Silver plan.
Gold: Higher monthly premiums with lower costs when you use care. 

How do I choose the right plan?

Consider your monthly budget, how often you expect to use healthcare, and what you may pay when you receive care. Also check whether your preferred doctors, hospitals, and prescriptions are included. The lowest monthly premium isn’t always the lowest-cost plan overall, so compare both monthly and out-of-pocket costs before deciding.

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