If you need health insurance, now is the time to act.
Open enrollment, your annual opportunity to pick a health plan for next year, opened Nov. 1 and runs through Jan. 15 for the federal marketplace at HealthCare.gov and most state exchanges.
This 11-week period is the only time you can sign up for coverage under the Affordable Care Act unless you later have a qualifying life event, such as getting married or divorced.
Enrollment in the marketplace plans hit a record high last year of 14.5 million, a roughly 21% increase over the prior year, according to a report by the Centers for Medicare & Medicaid Services.
Who Can Enroll in a Health Care Marketplace Plan?
Marketplace health insurance is available only to U.S. citizens and legal residents.
Coverage is aimed at people who can’t get health insurance through their employer.
That can include part-time employees, freelancers, gig workers, college students, independent contractors, people who are self-employed or unemployed and early retirees under 65, among others.
It’s not intended for those covered by government programs such as Medicaid, Medicare, Tricare or CHIP (Children’s Health Insurance Plan).
While you can technically sign up for a marketplace plan if your employer offers health insurance, sticking with your employer-sponsored coverage will likely be your cheapest option.
That’s because money-saving premium subsidies are only available to workers whose employer coverage is deemed “unaffordable” — that is, your share of the monthly premium in the lowest-cost plan is more than 9.12% of your household income in 2023.
How to Sign Up for ACA Health Insurance
Start by going to HealthCare.gov. From the home page, you can either enroll in coverage for the first time, view your existing plan or compare plans.
If you’re already enrolled in a plan, it will renew automatically. But experts suggest visiting the website to update your information and shop around for plans. You might qualify for better coverage.
If you sign up for a marketplace plan by Dec. 15, your coverage will start Jan. 1, 2023. Open enrollment ends Jan. 15.
Some states operate their own exchanges. If you live in California, Colorado, Connecticut, Idaho, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Washington or the District of Columbia, you must apply through your state.
Here’s how to estimate your 2023 income for the application along with a checklist of information you’ll need, such as household size, the Social Security numbers and birthdates of your family members, W-2 forms and policy numbers of any current health insurance.
You can also apply for a marketplace plan by phone, through an agent or broker, in person with help from a navigator — a person specially trained to walk you through the process — or by mail with a paper application.
How Much Do Marketplace Plans Cost?
You’ll pay different premiums and out-of-pocket costs depending on the plan you choose. You’ll pay only up to an out-of-pocket maximum, and there are no yearly or lifetime dollar limits.
A majority of the 14.5 million people enrolled in insurance through the public marketplace receive subsidies to help lower their premiums. (Technically, they’re tax credits).
Premiums for health insurance plans on the marketplace are increasing in 2023, but those tax credit subsidies can help keep your costs down.
There is no income cap to qualify for subsidies, but the lower your income, the higher the premium tax credit you’re eligible for.
Here’s how those subsidies break down:
- If you make up to 150% of the federal poverty level ($20,385 for an individual and $27,465 for a couple): You can get an ACA plan with no monthly premium.
- If you earn up to 400% of the federal poverty level ($54,360 for an individual and $73,240 for a couple): You can qualify for sliding-scale subsidies to lower your premiums.
- If you earn more than 400% of the federal poverty level: You may still qualify for savings on a 2023 marketplace insurance plan. You won’t pay more than 8.5% of your household income toward premiums.
Marketplace subsidies are also based on your age and the second-lowest-cost “silver” plan in your geographic area (which may or may not be the plan you enroll in).
Health care subsidies have been around since 2014, shortly after the marketplace was launched as a provision of the Affordable Care Act. Enhanced subsidies were made available under the American Rescue Plan Act in 2021 and later extended through 2025 under the Inflation Reduction Act.
What Kind of Health Insurance Plans Are Available?
Insurers sell plans in four categories: Bronze (the least coverage and the lowest premiums), Silver, Gold and Platinum (the most coverage and the highest premiums). Depending on where you live, you may find several types of plans at each level.
You’ll want to make sure your doctors are in the plan’s network and that your prescription medications are covered.
There are several types of health insurance plans available. You may have a choice of:
- An exclusive provider organization (EPO), which covers services provided only by doctors and hospitals in a network, except in an emergency. You aren’t required to choose a primary care provider.
- A health maintenance organization (HMO), which requires you to obtain care from doctors who work for or contract with the HMO, except in an emergency. You may have to live or work in the HMO service area.
- A point of service plan (POS), which charges less if you use health care providers that belong to a network and requires you to get a referral from your primary care doctor to see a specialist.
- A preferred provider organization (PPO), in which you pay less for in-network providers, but you can go to out-of-network providers for an additional fee. You don’t need a referral to go to a specialist.
Catastrophic Insurance
Catastrophic insurance is another alternative available to people under the age of 30. You can also qualify if you can claim a hardship exemption, such as homelessness, domestic violence or bankruptcy.
On the upside, catastrophic plans cover the 10 essential health benefits, offer specific preventive services for free and cover at least three visits to a doctor annually before the deductible is met. They also cost about one-third as much as more comprehensive plans.
The big downside is that the deductible — the amount you pay before the insurance company starts paying its share — is $9,100 for 2023.
Another drawback is you can’t use a premium tax credit on a catastrophic plan.
If you qualify for a premium tax credit based on your income, you might want to check out a Bronze or Silver plan instead. They’re likely to be a better value.
What’s Covered by Marketplace Plans?
Plans that comply with the Affordable Care Act cannot discriminate against people with pre-existing conditions. They also must cover birth control and breastfeeding equipment and counseling, plus 10 “essential” services:
- Outpatient care
- Emergency services
- Hospitalization
- Pregnancy, maternity and newborn care
- Mental health and substance abuse services
- Prescription drugs
- Mental and physical rehabilitation for people with injuries, disabilities or chronic conditions
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric treatment, including dental and vision care
Rachel Christian is a Certified Educator in Personal Finance and a senior writer for The Penny Hoarder. Susan Jacobson, a former associate editor, contributed.
