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Health insurance, explained

Plain answers to the questions we hear most. Short on time? Call or text us and a licensed agent will walk you through it for free.

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The basics
Plan types
Metal levels
What it costs
Savings
Open Enrollment
Can I enroll now?
For businesses
Glossary

The basics

Every health plan has a few moving parts. Knowing them makes plans much easier to compare.

Premium: What you pay every month to keep the plan, whether or not you see a doctor.
Deductible: What you pay for covered care before the plan starts paying its share. Preventive care, and on many plans some visits, are covered before the deductible.
Copay: A set fee for a visit or prescription, like $30 to see your doctor.
Coinsurance: Your share of the bill, as a percentage, after the deductible. For example, you pay 20% and the plan pays 80%.
Out-of-pocket maximum: The most you pay for covered care in a year. Once you reach it, the plan pays 100% of covered in-network care for the rest of the year.
Network: The doctors, hospitals, and pharmacies that agreed to the plan's prices. Staying in network usually costs much less.

A low premium usually means a higher deductible, and the reverse. The right balance depends on how much care you expect to use.

Plan types: HMO, PPO, EPO, and POS

HMO: You choose a primary care doctor and usually need a referral to see a specialist. Only in-network care is covered, except emergencies. Often the lowest premiums.
PPO: See any doctor, in or out of network, without referrals. Out-of-network care costs more. Usually higher premiums.
EPO: No referrals needed, but only in-network care is covered, except emergencies.
POS: A mix of HMO and PPO: a primary care doctor and referrals, with some out-of-network coverage.

Emergency care is covered on every Marketplace plan, even at an out-of-network hospital.

Metal levels: Bronze, Silver, Gold, Platinum

Marketplace plans come in four levels. The level tells you how costs are split between you and the plan, not the quality of care.

Bronze: Lowest monthly premium, highest costs when you get care. Mainly protects you from a very large bill.
Silver: Middle premiums and costs. If your income qualifies, Silver plans can come with extra savings that lower your deductible and copays.
Gold: Higher premiums, lower costs when you get care. A good fit if you see doctors often.
Platinum: Highest premiums, lowest costs when you get care. Not offered everywhere.

Catastrophic plans are also open to people under 30 and to some people with a hardship exemption. They have very low premiums and very high deductibles.

What coverage costs

Under the Affordable Care Act, a Marketplace plan's price can depend on only four things: your age, where you live, whether you use tobacco, and how many people are on the plan. Insurers can't charge you more for a health condition, and can't charge women more than men.

That's the price before savings. Most people who buy their own coverage qualify for a tax credit that lowers it.

The real cost of a plan is the premium plus what you'll spend on care. We compare both, using your doctors and prescriptions, so you see the yearly total, not just the monthly price.

Savings and tax credits

The premium tax credit lowers your monthly premium. It is based on your household's estimated income for the year of coverage and your household size.

For 2027 coverage, the credit is generally for households with income between 100% and 400% of the federal poverty level. The larger, temporary credits that removed the 400% limit expired at the end of 2025. Congress was still debating bringing them back in fall 2026; we'll tell you if that changes.
You can take the credit each month to lower your bill, or claim it when you file taxes.
At tax time the credit is matched to your actual income. Starting with 2026 coverage there is no cap on paying back extra credit, so if your income goes up, update it with the Marketplace right away.
Silver plans can include extra savings on deductibles and copays for incomes up to 250% of the poverty level.
If a job offers you affordable coverage, you usually can't get the credit.
Starting in 2027 the credit ends for most lawfully present immigrants, except green card holders and a few specific groups. Ask us and we'll check your situation.

Open Enrollment for 2027

Open Enrollment is the yearly window when anyone can sign up for or change a Marketplace plan.

Starts November 1, 2026.
Pick a plan by December 15, 2026 for coverage that starts January 1, 2027.
Ends January 15, 2027 in states that use HealthCare.gov. Plans picked after December 15 start February 1.
Some states run their own Marketplace with different deadlines.

Already have a plan? Review it every year. Premiums, networks, and drug lists change, and staying put isn't always the best deal.

Book a free 2027 plan review

Can I enroll now?

Outside Open Enrollment you need a Special Enrollment Period. It usually lasts 60 days after a qualifying life event, such as losing other coverage, moving, getting married, or having or adopting a baby.

Medicaid and CHIP take applications all year.

See common life changes

Coverage for businesses

Group health plan: The business picks one or more plans and pays part of the premium. Small-group plans can usually start any month of the year.
ICHRA: The business gives each employee a set, tax-free amount, and each employee buys their own individual plan.
QSEHRA: A similar arrangement for businesses with fewer than 50 full-time employees that don't offer a group plan.
Small business tax credit: Businesses with fewer than 25 full-time employees and modest average wages may qualify when they buy coverage through the SHOP Marketplace.

Get a group quote

Glossary

Advance premium tax credit (APTC): The tax credit paid to your insurer each month to lower your premium.
Cost-sharing reductions (CSR): Extra savings on Silver plans that lower deductibles and copays for eligible incomes.
Essential health benefits: Ten kinds of care every Marketplace plan must cover, including emergencies, hospital stays, pregnancy and newborn care, mental health, prescriptions, and preventive care.
Federal poverty level (FPL): An income measure set by the federal government each year and used to decide who qualifies for savings.
Formulary: The plan's list of covered prescription drugs.
Health savings account (HSA): A tax-advantaged account you can pair with an HSA-eligible plan to pay for care.
Preventive care: Checkups, screenings, and vaccines that Marketplace plans cover at no cost when you use an in-network provider.
Prior authorization: Approval the plan requires before it covers some services or drugs.
Qualifying life event: A change, like losing coverage or moving, that can open a Special Enrollment Period.
Referral: Approval from your primary care doctor to see a specialist. Required by many HMO plans.
Special Enrollment Period (SEP): A window outside Open Enrollment to sign up after a qualifying life event.

General information about HealthCare.gov rules for 2027 coverage, not legal or tax advice. States that run their own Marketplace can have different dates and rules. Last reviewed October 2026.