ACA health insurance
If you buy your own health insurance, the Marketplace may offer plans that fit your needs and budget. We help you understand your financial assistance eligibility and compare available plans.
The Marketplace is where individuals and families who do not have coverage through an employer, Medicare or Medicaid buy health insurance under the Affordable Care Act. Every plan sold there covers pre-existing conditions and the same ten categories of essential benefits.
Self-employed, between jobs, retired before 65, working somewhere that does not offer insurance: this is the coverage built for those situations. A licensed agent compares the plans available in your county and checks whether you qualify for financial assistance before you choose.
Marketplace financial assistance is based on factors including household income and household size. Two families looking at the same plan can pay very different premiums after financial assistance is applied.
That is why comparing the full cost—not just the advertised premium—is important. Not everyone qualifies, and the only way to know is to check.
Premium tax credits depend on your household income and size. We check what you qualify for before you look at a single plan.
A licensed agent walks through the Marketplace plans available in your county with the assistance already applied.
We look at the monthly premium alongside what you would pay when you actually use care. You decide; the agent explains.
A lower monthly premium can come with a higher deductible or higher costs when you use medical care. A higher-premium plan may make more sense for someone who expects to use healthcare regularly.
Every Marketplace plan is Bronze, Silver, Gold or Platinum. The metal says nothing about quality of care; it is the split between what you pay in premium each month and what you pay when you use care. The percentages are averages across a typical population, set by federal rule.
Suits: people who want protection against a serious illness or accident and expect to use little routine care. The deductible can run into the thousands.
Suits: most subsidy-eligible buyers. If your income qualifies for extra savings, Silver pays 73–96% instead, and only Silver carries that discount.
Suits: people who use care regularly and would rather pay a steady premium than large bills.
Suits: people with ongoing, predictable medical needs. Not offered in every county.
Percentages are the tiers’ actuarial values as published by HealthCare.gov. What any one person pays varies by plan and by how much care they use. A fifth category, Catastrophic, is limited to people under 30 or with a hardship exemption.
Every Marketplace plan covers the ten essential health benefit categories required by the Affordable Care Act. What changes from plan to plan is the network, cost-sharing, covered services within those categories and other plan details.
Outpatient care you get without being admitted to a hospital
Emergency room care
Surgery and overnight stays
Both before and after birth
Including behavioral health treatment
Covered medications, per the plan’s formulary
Help gaining or recovering skills after an injury, disability or chronic condition
Tests and blood work
Screenings, vaccines and chronic disease management
Including dental and vision care for children (adult dental and vision are not essential health benefits)
Plans must also cover birth control and breastfeeding support. Source: HealthCare.gov, what marketplace plans cover.
The individual and family health plans sold through the health insurance Marketplace under the Affordable Care Act. Every plan covers the ten essential health benefits, no plan can decline you or charge you more for a pre-existing condition, and financial assistance toward the premium is available to those who qualify based on household income and size.
U.S. citizens and lawfully present residents who do not have affordable coverage through an employer, Medicare or Medicaid. There is no health screening. Most Marketplace buyers are under 65; people turning 65 generally move to Medicare.
It depends on the plan tier, your county, your age, your household size and whether you qualify for financial assistance. Two households looking at the same plan can pay very different amounts after assistance. The realistic way to find out is to have your assistance checked and compare the plans in your county with it applied.
Premium tax credits are based on your household income and household size, and they are applied directly to your monthly premium. Not everyone qualifies. We check what you qualify for before you pick a plan, so you are comparing what you would actually pay.
Yes. Marketplace plans cannot refuse to cover you, charge you more or exclude treatment because of a health condition you had before your coverage started.
The four Marketplace plan categories. They describe how costs are split between you and the plan, not the quality of care. Bronze has the lowest premium and the highest costs when you use care; Platinum is the reverse. Silver is the only tier that carries extra cost-sharing savings for people whose income qualifies. See the tier comparison.
Losing job-based coverage is a qualifying life event that opens a Special Enrollment Period, generally 60 days, to enroll in a Marketplace plan outside Open Enrollment. Call promptly; the window is short.
During Open Enrollment, the annual window that generally runs from November into January (exact dates vary by state), or during a Special Enrollment Period opened by a qualifying life event such as losing other coverage, moving, marriage or a new child.
Yes. The Marketplace is built for people who do not get insurance through an employer, and self-employed people are among its most common buyers. Financial assistance is based on your household income, including self-employment income.
Most people become eligible for Medicare at 65 and leave their Marketplace plan then. If you are approaching 65, a licensed agent can walk you through how Medicare Advantage compares with Original Medicare and when your enrollment window opens.
Turning 65, or already on Medicare? Learn how Medicare Advantage works. Looking at burial coverage? Compare final expense insurance rates. Meet the agency or talk to a licensed agent.
States where Senior Solutions Insurance is licensed and serves ACA customers. State-specific guides are published for selected states.
A real person calls you back.Licensed agents in our Greenwood Village, Colorado office.
During business hours: Monday to Friday 9 to 7, Saturday 9 to 5, Mountain Time.
Tell us whether you need help with Final Expense insurance, Medicare or another health coverage question. Your agent reviews the options that apply to your situation.
We explain the important differences and next steps. If an option makes sense, we can help you move forward. There is no fee for speaking with us.
