How does the health insurance Marketplace work?

How it works, step by step

1. Find your state's Marketplace. Start at HealthCare.gov and pick your state. If your state runs its own site, you'll be sent there. For example, Oregon residents will use ExploreHealthOR.gov for 2027 coverage starting November 1.
2. Fill out one application. You list your household and your estimated income for the year you want coverage, not last year's.
3. Get your eligibility results. The application tells you if you qualify for a premium tax credit, extra savings on out-of-pocket costs, or Medicaid or CHIP.
4. Compare plans. Look at the premium after savings, the deductible, the out-of-pocket maximum, and whether your doctors and prescriptions are covered.
5. Pick a plan and pay the first premium. Coverage doesn't start until the first premium is paid.

Who can buy a Marketplace plan

HealthCare.gov says you must live in the U.S., be a U.S. citizen or national or a lawfully present non-citizen, and not be incarcerated. If you have Medicare, you can't enroll in a Marketplace health plan.

• Anyone eligible can buy a plan at full price. Savings depend on income and other coverage.
• If your job offers coverage that is affordable and meets minimum standards, you generally won't qualify for a tax credit on a Marketplace plan.
• Starting January 1, 2027, a federal law change limits Marketplace savings to certain immigration statuses. HealthCare.gov lists lawful permanent residents, Cuban or Haitian entrants and COFA migrants. Other lawfully present immigrants may still buy coverage, but without savings.
• Self-employed people with no employees use the individual Marketplace. See health insurance for self-employed people.

Metal levels: how costs are split

Metal levels describe cost sharing, not quality. Every Marketplace plan covers the same 10 essential health benefits, and no plan can turn you down or charge you more for a pre-existing condition. See ACA-compliant health insurance. Catastrophic plans are a fifth option for people under 30 or with a hardship or affordability exemption. For 2026, the most you can be asked to pay in a year for in-network covered care is $10,600 for one person and $21,200 for a family. For 2027 it rises to $12,000 and $24,000.

How the savings work

• Premium tax credit: lowers your monthly premium. HealthCare.gov lists the income range as 100% to 400% of the federal poverty level. The temporary rule that removed the 400% cap ended after 2025. You can take the credit in advance or at tax time. See premium tax credit.
• Cost-sharing reductions: lower deductibles, copays and coinsurance for people who qualify, but only in Silver plans.
• Medicaid and CHIP: free or low-cost coverage for people with lower incomes. You can apply any time of year through the same application.

Ways to apply

• Online at HealthCare.gov or your state's Marketplace site (the fastest way).
• By phone at 1-800-318-2596 (free help, in other languages too).
• In person with local help you can find through HealthCare.gov.
• Through a certified enrollment partner, such as an insurance company or online seller.
• On a paper application; results arrive by mail within about 2 weeks.

Gabriel can quote Marketplace plans for your ZIP code and household, show the price after any tax credit, and open your own application with a licensed agent in most states. You choose the plan and finish the application.

Gabriel is not an insurer. Health insurance quotes and enrollment are handled by Gabriel Labs, Gabriel's separately licensed insurance agency. Gabriel membership is not health insurance and doesn't replace a Marketplace plan's protection against large medical bills.