Answers to the questions we hear most.
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Eligibility for affordable or subsidized health insurance generally depends on your household income, family size, age, and state of residence. Many people who think they earn too much to qualify are surprised to find they're eligible for subsidies that significantly lower their monthly premium.
Costs vary widely based on income, age, location, and plan type. With subsidies, many people pay significantly less than the full premium price, and some qualify for plans with little to no monthly cost.
Yes. Certain life events — such as losing a job, getting married, having a baby, or moving — trigger a Special Enrollment Period that allows you to enroll in coverage outside the standard open enrollment window. See the full list in Qualifying Life Events Explained.
No. Checking your eligibility for affordable health coverage through our form is free and does not involve a credit check or any obligation to enroll.
Typically just basic details: your name, date of birth, zip code, height, and weight. This helps match you with plans available in your area and appropriate for your situation.
No. Submitting the eligibility form does not enroll you in any plan. It simply lets us determine what options may be available so we can follow up with you.
A deductible is the amount you pay for covered care out of your own pocket before your insurance starts paying its share. For example, if your plan has a $2,000 deductible, you generally pay the first $2,000 of covered costs yourself each year before the plan kicks in, though some services like preventive care are often covered before the deductible is met. See Marketplace Plan Tiers Explained for how deductibles vary by plan tier.
A copay is a fixed dollar amount you pay for a specific service, like $30 for a doctor visit, regardless of the total cost. Coinsurance is a percentage of the cost you pay instead, like 20% of a procedure's price, with your plan covering the rest. Plans often use a mix of both depending on the type of care.
Your premium is the amount you pay, usually monthly, just to keep your health insurance plan active, regardless of whether you use any medical care that month. This is separate from your deductible, copays, and coinsurance, which you only pay when you actually receive care.
Your out-of-pocket maximum is the most you'll have to pay for covered services in a plan year. Once you hit that amount through deductibles, copays, and coinsurance combined, your plan pays 100% of covered costs for the rest of the year.
Coverage for GLP-1 medications varies significantly by plan and by the reason they're prescribed. Many plans cover GLP-1 drugs when prescribed for type 2 diabetes, but coverage for weight-loss use specifically is far less consistent and often requires prior authorization or proof that other treatments have been tried first. See Prior Authorization Explained for more on how that approval process works. Because coverage rules differ from plan to plan, the only way to know what a specific plan covers is to check that plan's formulary directly or ask during enrollment.
No. Under current federal law, marketplace health plans cannot deny you coverage, charge you more, or exclude treatment for a pre-existing condition. This protection applies regardless of your health history, and is part of the essential health benefits every marketplace plan must follow.
An HMO (Health Maintenance Organization) generally requires you to use doctors within its network and get referrals to see specialists, usually at a lower cost. A PPO (Preferred Provider Organization) offers more flexibility to see out-of-network providers and specialists without a referral, typically at a higher premium. The right choice depends on whether you prioritize cost or flexibility. Read more in In-Network vs. Out-of-Network Explained.
There is currently no federal tax penalty for not having health insurance, though some states have their own individual mandate penalties. The bigger risk is financial: without coverage, you're responsible for the full cost of any medical care, which can be significant even for a single emergency room visit or hospital stay.
COBRA lets you temporarily keep your former employer's health plan after leaving a job, but you typically pay the full premium yourself, which is often expensive. Marketplace insurance is a separate set of plans you can shop for independently, and many people qualify for subsidies that make marketplace coverage significantly cheaper than COBRA for the same time period.
Losing job-based coverage is a qualifying life event that opens a Special Enrollment Period, giving you a window to enroll in a marketplace plan outside the normal schedule. You may also be offered COBRA continuation coverage through your former employer, but it's worth comparing the cost against marketplace options first.
Under current rules, you can generally stay on a parent's health plan until age 26. Turning 26 and losing that coverage is a qualifying life event, which opens a Special Enrollment Period so you can enroll in your own plan without waiting for the next open enrollment.
Yes. Having a baby is a qualifying life event that opens a Special Enrollment Period, letting you add your newborn to an existing plan or enroll in new coverage outside the standard open enrollment window. There's typically a limited window after the birth to make this change, so it's best to act promptly.
Most marketplace health plans are required to cover mental health and substance use services as one of the essential health benefits. The specific providers covered, copay amounts, and number of visits allowed vary by plan, so it's worth checking a plan's details if mental health coverage is a priority.
Routine adult dental and vision care is generally not included in standard marketplace health plans and is usually sold as a separate add-on plan. Pediatric dental and vision care, however, is considered an essential health benefit and is included for children under most marketplace plans.
A Health Savings Account (HSA) is a tax-advantaged savings account you can use alongside certain high-deductible health plans to pay for qualified medical expenses. It isn't a type of insurance itself, but a way to set money aside, tax-free, specifically for healthcare costs, with unused funds rolling over year to year.