Pathways to Coverage

The ACA Marketplace

Private health plans with income-based subsidies. 4 in 5 enrollees pay $10/month or less.

Last updated: May 2026

The ACA Marketplace (HealthCare.gov and state-run exchanges) is where individuals and families who don't get coverage through a job or government program buy private health insurance. About 4 in 5 enrollees qualify for premium tax credits that bring monthly premiums to $0–$10.

Open Enrollment for 2026 coverage

  • November 1, 2025 – January 15, 2026 on HealthCare.gov.
  • Enroll by December 15, 2025 for coverage starting January 1, 2026.
  • State-run exchanges (CA, NY, NJ, WA, etc.) often have longer windows.

Special Enrollment Periods (SEPs)

Outside of Open Enrollment you can still sign up within 60 days of a qualifying life event:

  • Losing job-based coverage, Medicaid, or CHIP
  • Marriage, divorce, birth, adoption, or death in the household
  • Moving to a new ZIP code or county
  • A change in income that makes you newly eligible for tax credits
  • Becoming a U.S. citizen or gaining lawful status

Households earning under 150% FPL can enroll any time of year.

Premium Tax Credits

Premium tax credits cap how much you pay for a benchmark Silver plan at a percentage of your income, on a sliding scale up to 8.5% — even for households above 400% FPL, thanks to the enhanced subsidies currently extended through 2025. The credit is applied directly to your monthly premium so you never have to wait for a refund.

Metal tiers — Bronze, Silver, Gold, Platinum

  • Bronze: lowest premium, highest out-of-pocket. Best for the healthy.
  • Silver: balanced — and the only tier eligible for cost-sharing reductions.
  • Gold: higher premium, lower out-of-pocket. Best if you use care often.
  • Platinum: highest premium, lowest out-of-pocket. Rare and pricey.
  • Catastrophic: only for under-30s and hardship exemptions.

What every Marketplace plan must cover

  • Preventive care (screenings, vaccines, annual physicals) at $0
  • Emergency services, hospitalization, and prescription drugs
  • Pregnancy, maternity, and newborn care
  • Mental health and substance use treatment
  • Pediatric services, including dental and vision
  • No denials for pre-existing conditions and no lifetime caps

See what you qualify for — free, in under 2 minutes.

Answer a few quick questions and a licensed advisor in your state will walk you through your options. No SSN required, no obligation.