You must sign up during open enrollment

You can only sign up or make changes to your individual health plan during open enrollment. The open enrollment period in most states is between Nov. 1 and Jan. 15. There are a handful of states that have slightly different open enrollment periods:

  • California -- Nov. 1 to Jan. 31
  • District of Columbia -- Nov. 1 to Jan. 31
  • Idaho -- Nov. 1 to Dec. 15
  • Maryland -- Nov. 1 to Dec. 15
  • Massachusetts -- Nov. 1 to Jan. 23
  • New Jersey -- Nov. 1 to Jan. 31
  • New York -- Nov. 16 to Jan. 31
  • Rhode Island -- Nov. 1 to Jan. 31
You can’t sign up for or change a health plan in the exchanges outside of the open enrollment period unless you have a qualifying life event. This could be losing eligibility for other health coverage, such as your spouse losing a job. You can also qualify for a special enrollment for certain life events, including having a child, getting married or moving.

If you go through a qualifying life event, you can sign up for a plan or change an existing plan outside of open enrollment.

Gather the necessary documents

Before digging into the different ACA exchange plans, let’s go over what you will need in the application process.

Here’s what you should gather before looking for a plan:

  • Name, contact information, date of birth and social security number for you and every member of your household who needs coverage or is listed on your federal tax return.
  • Incarceration status for anyone for whom you’re applying.
  • Immigration status, document type and number for any member of your household who is an immigrant.
  • Job information about you and every member of your household. That includes wages and employer work information. You’ll want to fill out the Employer Coverage Tool for any household member with a job who’s getting coverage through your plan.
  • Your other household income. You’ll include child support, veterans’ payments and Supplemental Security Income (SSI).
  • A list of federal tax deductions that you claim.
  • Specifics about any health insurance coverage anyone has in your household. Include coverage type, name of person, insurance company, policy number, etc.

You can start your application process once you have all the information that you’ll need.

Application process

While there is still an application process, the ACA forbids a health insurer from denying you or charging you much higher rates because of your health status.

Before the ACA, insurers could reject people, charge them exorbitant fees or drop them if they used health insurance too much. The ACA ended those practices. You’re now guaranteed health insurance regardless of your health.

To apply for an ACA plan , you can go online, by phone, with in-person help, through an agent or broker or with a paper application. You can call 1-800-318-2596.

If you go online, you’ll set up an account with a username, password and security questions. You can then move onto the application. You’ll choose your state and it will take you to the right place. Some states have their own marketplaces. The site will transport you there if needed.

Use the information you gathered earlier to answer all the relevant questions, such as your personal information.

You may be eligible for an ACA subsidized plan

Once the website has all of your information, it will tell you if you’re eligible for subsidies or credits. The ACA plans offer tax credits and lower rates for people who fall below certain income thresholds.

For instance, you qualify for tax credits if you earn up to 400% of the federal poverty level. The federal poverty level is $30,000 for a family of four in 2023. You will be informed during the application process if you qualify.

The health insurance exchange website provides cost information for each plan with your income in mind.

Health insurance finder tool

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COBRA

Consolidated Omnibus Budget Reconciliation Act
People who lose their employer-sponsored health insurance may qualify for a COBRA plan. COBRA lets you keep your former employer's health plan, but you're responsible for paying all of the costs, including your former employer's portion.
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How much is your family income?

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Medicare

People who are 65 and over qualify for Medicare. You can choose Original Medicare (also called Parts A and B), which is offered by the federal government, or Medicare Advantage (also called Part C), which private insurers provide. The average annual premium for Original Medicare is about $1,600. Medicare Advantage's average yearly premium is $336, but you may have higher out-of-pocket costs than Original Medicare.
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Medicaid

Low-income Americans qualify for Medicaid. Thirty-eight states expanded Medicaid eligibility, so lower-middle-class Americans may also be eligible in those states. Medicaid offers comprehensive benefits, but at little to no cost depending on your income. Each state has its own eligibility. Some states are flexible with Medicaid eligibility for people who are pregnant, a parent or disabled. If your household income is below 138% of the federal poverty level, you're likely eligible for Medicaid if you live in a Medicaid expansion state. That level is $17,609 for an individual, $23,791 for a family of two, $29,974 for a family of three and $36,156 for a family of four. Non-Medicare expansion states have stricter income guidelines. Check with your state's Medicaid program to see if you qualify.
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Parent's employer-based health insurance

The Affordable Care Act lets children stay on a parent's health plan until the age of 26. Having a child on a parent's health plan may or may not increase premiums. It depends on whether you already have family coverage when adding the child to the plan. If a parent already has family coverage, adding a child won't likely increase premiums. However, going from single or couple to family coverage could cause premiums to skyrocket. The average single coverage employer-sponsored plan premium is $1,186. The average family plan is $5,447.
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Spouse's employer-based health insurance

Most employers allow employees to add spouses to their health insurance. Going from single health coverage to a family plan may triple or quadruple your premiums. The average single coverage employer-sponsored plan premium is $1,186. The average family plan is $5,447. Not all jobs allow for spouse's coverage, so you'll want to check with your employer to make sure it's an option.
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Employer-based health insurance

Most people with private health insurance get their coverage through a job. employer-sponsored health insurance is usually cheaper than individual health insurance unless you qualify for Affordable Care Act subsidies. Job-based plans are generally less expensive because businesses often pick up more than half of employer-sponsored health insurance premiums. Kaiser Family Foundation estimates the average premiums for a single coverage employer-sponsored health plan is $1,186 and the average family plan is $5,447 annually.
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  • PPO
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Employer plans are often one of these types of four plans. Click on each one to find out more.
  • PPO
  • HMO
  • HDHP
  • EPO

Preferred-provider Organization (PPOs)

  • Pay higher premiums with a lower deductible
  • You have access to more providers, but pay much more for health insurance
  • You don't want to choose a primary care physician
  • You don't want to get a referral
  • You want the ability to get out-of-network care
Preferred-provider organization (PPOs) plans are the most common type of employer-based health plan. PPOs have higher premiums than HMOs and HDHPs, but those added costs offer you flexibility. A PPO allows you to get care anywhere and without primary care provider referrals. You may have to pay more to get out-of-network care, but a PPO will pick up a portion of the costs.
Find out more about the differences between plans

Health maintenance organization (HMO)

  • Pay higher premiums with a lower deductible
  • Restricted network of providers with lower premiums
  • You want to choose a primary care physician
  • You don't mind getting a referral
  • You don't care about the ability to get out-of-network care
Health maintenance organization (HMO) plans have lower premiums than PPOs. However, HMOs have more restrictions. HMOs don't allow you to get care outside of your provider network. If you get out-of-network care, you'll likely have to pay for all of it. HMOs also require you to get primary care provider referrals to see specialists.
Find out more about the differences between plans

High-deductible health plans (HDHPs)

  • Pay lower premiums with a higher deductible
High-deductible health plans (HDHPs) have become more common as employers look to reduce their health costs. HDHPs have lower premiums than PPOs and HMOs, but much higher deductibles. A deductible is what you have to pay for health care services before your health plan chips in money. Once you reach your deductible, the health plan pays a portion and you pay your share, which is called coinsurance.
Find out more about the differences between plans

Exclusive provider organization (EPO)

  • Restricted network of providers with lower premiums
  • You don't want to choose a primary care physician
  • You don't want to get a referral
  • You don't care about the ability to get out-of-network care
Exclusive provider organization (EPO) plans offer the flexibility of a PPO with the restricted network found in an HMO. EPOs don't require that members get a referral to see a specialist. In that way, it's similar to a PPO. However, an EPO requires in-network care, which is like an HMO.
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Individual insurance/Affordable Care Act
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
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To find the kind of ACA plan for you, would you rather...
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Individual insurance/Affordable Care Act
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
Know more individual insurance / ACA
People who would prefer to pay lower premiums with a higher deductible may want the below plans
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silver shield

Silver is the second most popular plan in the ACA exchanges, with 35% of people with a Silver plan. Silver has lower premiums than any plan except for Bronze. However, it has lower out-of-pocket costs than Bronze. Silver plans pick up 70% of the costs, while members pay 30% The average single coverage in a Silver plan is $481 monthly and $1,179 for a family plan.

Bronze is the most popular type of plan in the ACA exchanges, with 41% of members with a Bronze plan. These plans have the lowest premiums, but also the highest out-of-pocket costs in the exchanges. Bronze plans pick up 60% of the costs, while members pay 40%. The average single coverage monthly cost in a Bronze plan is $440 and $1,080 for a family plan.

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Individual insurance/Affordable Care Act
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
Know more individual insurance / ACA
People who would prefer to pay higher premiums with a lower deductible may want the below plans
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platinum shield

Platinum plans have the highest premiums but the lowest out-of-pocket costs. So, you pay more for the coverage initially but less than other plans when you need health care services. Platinum plans pick up 90% of the costs, while members pay 10%, Not many health insurers offer Platinum plans. Only 2% of members in ACA plans have a Platinum plan, so you may have trouble finding one. The average monthly premiums for single coverage in a Platinum plan is $706 and the average family coverage costs $1,460.

Gold plans have lower premiums than Platinum, but higher premiums than Silver and Bronze. Gold also has lower out-of-pocket costs than Silver and Bronze, but higher than Platinum. Gold plans pick up 80% of the costs, while members pay 20%. The average monthly premium for a single Gold plan is $596. Family coverage averages $1,426 per month.

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Types of ACA plans

Once you enter in the information, the health insurance exchange website tells you what plans are available. 

There are four “metal” plans in the ACA exchanges:

  • Bronze -- Insurer pays 60%; you pay 40% (these plans have the cheapest premiums, but highest out-of-pocket costs; it's also the most popular type of ACA plan)
  • Silver -- Insurer pays 70%; you pay 30% (higher premiums than Bronze, but fewer out-of-pocket costs than Bronze)
  • Gold -- Insurer pays 80%; you pay 20% (higher premiums than Silver, but lower out-of-pocket costs than Silver)
  • Platinum -- Insurer pays 90%; you pay 10% (highest premiums, but lower out-of-pocket costs than the other three plans; only 2% of ACA plan members have a Platinum plan and you may have trouble finding one in your area)

You might be tempted by a Bronze’s plans low premiums. However, if you expect to visit medical providers frequently, you’ll pay more in out-of-pocket costs than if you had a different plan. Therefore, a Gold or Platinum plan might save you money.

If you don’t expect frequent visits to medical providers, a Bronze or Silver plan might work best. 

Also, note that the less expensive plans might have limited provider and hospital networks. These narrow-network plans could mean you won’t get to see your doctor or go to the hospital of your choice. Confirm that your doctor and hospital takes the specific plan before signing up.

After you evaluate your options and decide how you’ll pay the premiums, you’ll choose a plan and sign up.

Make sure to consider your next year of potential health costs when making your decision. Once you find the plan that best fits your needs, the website will let you choose your plan and you’ll usually get coverage on the first day of the next month.