What Is Marketplace Health Insurance (ACA)?

Section 1: What Is Marketplace Health Insurance (ACA)?

Your Complete Guide to Affordable Care Act Coverage in 2025

Introduction to Marketplace Health Insurance

Marketplace health insurance, also known as Affordable Care Act (ACA) coverage or Obamacare, is a health insurance option made available through the federal and state health exchanges. Established under the ACA in 2010, these plans are designed to make healthcare accessible and affordable for all Americans, regardless of pre-existing medical conditions or income.

Marketplace plans follow strict federal regulations and include a set of “Essential Health Benefits”, cost protections, and income-based subsidies to reduce your monthly premiums and out-of-pocket costs.

Whether you're self-employed, between jobs, or don’t receive employer-based coverage, Marketplace insurance provides comprehensive, reliable healthcare coverage—often at little to no cost for qualifying individuals and families.

  Who Should Use the Health Insurance Marketplace?

Marketplace plans are ideal for:

• Individuals and families without employer-sponsored insurance

• Freelancers, gig workers, and small business owners

• Unemployed individuals

• Part-time workers

• Early retirees (under age 65)

• People aging off of their parents’ plan at 26

• Legal immigrants and green card holders

If you don’t qualify for Medicaid, Medicare, or employer coverage, the Marketplace is your best option for high-quality insurance with government-backed protections.

  What Do ACA Marketplace Plans Cover?

Marketplace plans must cover 10 essential health benefits, no matter what tier or company you choose:

1. Preventive & Wellness Services (including annual physicals, vaccines, screenings) 

2. Emergency Services (ambulance rides, ER visits) 

3. Hospitalization (surgery, overnight stays) 

4. Mental Health & Substance Use Services 

5. Maternity & Newborn Care 

6. Prescription Drugs 

7. Pediatric Care (including dental and vision) 

8. Rehabilitative Services & Devices 

9. Outpatient Care (primary & specialist visits) 

10. Laboratory Services (blood work, diagnostic tests) 

All plans must cover pre-existing conditions from day one. No denials. No waiting periods.

Plan Types: The Metal Tiers Explained

Marketplace health plans are categorized into four metal levels: Bronze, Silver, Gold, and Platinum. The metal tier doesn’t reflect quality—it reflects how costs are split between you and the insurance company.

Tier

Insurance Pays

You Pay

Best For

Bronze

~60%

~40%

Low premiums, high deductibles good for healthy individuals

Silver

~70%

~30%

Balance of cost and coverage eligible for extra discounts

Gold

~80%

~20%

Higher premiums, lower deductibles good for frequent care needs

Platinum

~90%

~10%

Highest monthly costs, lowest out-of-pocket best for chronic conditions

Silver Plans unlock Cost-Sharing Reductions (more below), so they’re often the most valuable for those receiving subsidies.

  Premium Tax Credits & Savings

A major benefit of the Marketplace is income-based financial assistance.

Premium Tax Credits

These reduce your monthly premium and are based on:

• Household income

• Family size

• ZIP code

• Age

You can apply these subsidies in advance to lower your bill each month or claim them later on your tax return.

Cost-Sharing Reductions (CSRs)

These reduce your:

• Deductibles

• Copayments

• Coinsurance

• Out-of-pocket maximums

Only available on Silver Plans and for incomes between 100%–250% of the Federal Poverty Level (FPL).

Example:

A family of four making $45,000/year in Georgia could:

• Qualify for a $0 monthly premium 

• Receive a Silver Plan with low copays and a $500 deductible 

CTA: Use Our Subsidy Calculator to Estimate Your Savings

Enrollment Periods: When Can You Apply?

There are two main ways to apply for Marketplace coverage:

Open Enrollment Period (OEP)

November 1 – January 15 each year

You can enroll, switch, or renew your plan during this window.

Special Enrollment Period (SEP)

You may qualify for a 60-day SEP if you experience a qualifying life event, such as:

• Loss of employer coverage

• Marriage or divorce

• Birth or adoption of a child

• Move to a new ZIP code

• Release from incarceration

• Gain lawful immigration status

Missing these windows means you could go uninsured unless you qualify for Medicaid or Short Term Insurance.

How to Apply for Marketplace Insurance

Applying through OnePoint Insurance Agency ensures you:

Understand your options

Get help with the subsidy process

Avoid costly mistakes or missed documents

Three Easy Steps:

1. Request a Free Quote via our website or call center 

2. Review plan options with a licensed advisor 

3. Submit application online with real-time subsidy eligibility check 

Call 770-884-8117 or click Get a Quote to get started.

State vs. Federal Marketplaces

Depending on your location, you may use:

• HealthCare.gov (federal exchange) 

• A state-based exchange, such as:

  • Covered California

  • Georgia Access

  • NY State of Health

  • Connect for Health Colorado

Our team is licensed in 15+ states and will guide you through the right platform.

ACA vs. Other Coverage Options

Feature

ACA Plans

Short Term Plans

Employer Coverage

Covers Pre-Existing Conditions

Yes

No

Yes

Preventive Services

Free

Not included

Often included

Income-Based Subsidies

Yes

No

No

Long-Term Coverage

Yes

Temporary

Yes

Mental Health & Maternity

Yes

No

Yes

Pros and Cons of Marketplace Plans

Pros

Cons

Covers pre-existing conditions

Can be expensive without subsidies

Comprehensive benefits

Deductibles can be high

Subsidies reduce premiums

Limited networks in rural areas

Annual enrollment guarantees access

Must wait for OEP or a qualifying event

  How to Renew or Change Your ACA Plan

• Each year during Open Enrollment, you can review changes to your current plan or switch to a new one.

• Plans may change their networks, premiums, or formulary lists.

• If you don’t update your income or household info, you could lose subsidies or owe money at tax time.

CTA: Schedule Your Free Annual Policy Review

  Real Customer Example

“I’m self-employed and thought I couldn’t afford good insurance. But OnePoint helped me get a Silver plan for $11/month and it even covered my annual mammogram for free.”

— Danielle P., Charlotte NC