Buy Health Insurance (Marketplace)

Open enrollment dates, subsidy eligibility, how to compare plans on healthcare.gov, what metal tiers mean, and how to enroll without overpaying.

Open Enrollment Dates

• The ACA Marketplace Open Enrollment Period runs November 1 through January 15 in most states — coverage starts January 1 if you enroll by December 15
• Special Enrollment Periods (SEP) open for 60 days after qualifying life events: losing job-based coverage, marriage, divorce, birth of a child, or moving to a new state
• If you miss Open Enrollment without a qualifying event, your next option is a short-term health plan — read their exclusions carefully, as they are not ACA-compliant and exclude pre-existing conditions

Subsidy Eligibility

• Estimate your premium tax credit using the KFF Health Insurance Marketplace Calculator at kff.org — you'll need your household size and estimated annual income
• Income between 100% and 400% of the Federal Poverty Level (FPL) qualifies for premium tax credits — in 2024, that's approximately $14,580–$58,320 for a single person
• Enhanced subsidies under the Inflation Reduction Act cap premiums at 8.5% of income for those above 400% FPL — apply even if you think you earn too much

Compare Plans at healthcare.gov

• Go to healthcare.gov (or your state's exchange if applicable) and create an account to see plans with personalized subsidy estimates
• Enter your expected annual income carefully — underestimating leads to repaying subsidies at tax time; overestimating means leaving money on the table
• Understand metal tiers: Bronze (lowest premium, highest deductible), Silver (mid-range, Cost Sharing Reduction eligible), Gold (higher premium, lower deductible), Platinum (highest premium, lowest deductible)
• If your income qualifies you for Cost Sharing Reductions (CSR), you must enroll in a Silver plan to access them — Bronze plans do not trigger CSR benefits
• Compare total annual cost, not just premium: (monthly premium × 12) + expected out-of-pocket spending = true annual cost

What to Check

• Confirm your preferred doctors and hospitals are in-network before enrolling — call the provider's office to verify; the plan's online directory is often outdated
• Check whether your current prescriptions are on the plan's drug formulary — each plan has a different drug tier structure and copay
• Understand the difference between deductible (what you pay before insurance kicks in), copay (flat fee per visit), and out-of-pocket maximum (most you'll ever pay in a year)

Enroll

• Complete enrollment on healthcare.gov or your state exchange by the deadline — you'll receive a summary of benefits confirmation by email
• Pay your first premium by the due date shown in your enrollment confirmation — coverage is not active until the first payment clears
• Set a calendar reminder for next Open Enrollment — your income, household size, or plan options may change, making re-shopping worthwhile every year