Everything You Need to Know About the Health Insurance Marketplace



The Health Insurance Marketplace (Marketplace) is a way to find health coverage that fits your budget and meets your needs. With one application, you can see all your options and enroll. The Marketplace is sometimes known as a health insurance Exchange.


When you use the Marketplace, you'll fill out an application and find out whether you can get lower costs on your monthly premiums for private insurance plans. You'll also find out if you qualify for lower out-of-pocket costs; or free or low-cost coverage available through Medicaid or the Children's Health Insurance Program (CHIP).


Open enrollment for 2021 Marketplace insurance will be from Nov. 1, 2020, to Dec. 15, 2020. Coverage will begin Jan. 1, 2021.


Insurance plans in the Marketplace are offered by private companies, and they all cover the same core set of benefits, known as essential health benefits. No plan can turn you away or charge you more because you have a pre-existing illness or medical condition, and plans can't charge women more than men.


The Marketplace simplifies your search for health coverage by gathering the options available for your area in one place. With one application, you can compare plans based on price, benefits, quality and other features important to you before you make a choice. You can also get help online, by phone, by chat or in person.


In the Marketplace, information about prices and benefits is written in simple language. You get a clear picture of what premiums you'd pay and what benefits and protections you'd get before you enroll. Compare plans based on what's important to you, and choose the combination of price and coverage that fits your needs and budget.


What does Marketplace health insurance cover?

All private health insurance plans offered in the Marketplace offer the same set of essential health benefits.


These benefits include at least the following items and services:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)

  • Emergency services

  • Hospitalization

  • Maternity and newborn care (care before and after your baby is born)

  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

  • Prescription drugs

  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities or chronic conditions gain or recover mental and physical skills)

  • Laboratory services

  • Preventive and wellness services and chronic disease management

  • Pediatric services

Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage, and you will be able to compare them side by side in the Marketplace.


Am I eligible for coverage in the Marketplace?

Most people are eligible for health coverage through the Marketplace.


To be eligible for health coverage through the Marketplace, you:

  • Must live in the United States

  • Must be a U.S. citizen or national (or be lawfully present)

  • Can't be currently incarcerated

What if I am a U.S. citizen living outside the United States?

U.S. citizens living in a foreign country for at least 330 days of a 12-month period are not required to get health insurance coverage under the health care reform law. If you're uninsured and living abroad, you don't have to pay the fee that other uninsured U.S. citizens may have to pay.