Who can get coverage through the Health Insurance Marketplace?
To buy a Marketplace plan, you must:
- Live in the United States
- Be a U.S. citizen, U.S. national, or lawfully present immigrant
- Not be in jail or prison serving a sentence (people waiting for trial can usually enroll)
You can enroll during Open Enrollment, or at other times if you qualify for a Special Enrollment Period.
Some rules changed recently. DACA recipients can no longer buy Marketplace plans. Starting in 2027, many lawfully present immigrants who are not green card holders can still buy a plan but can't get help paying for it. An agent can help you check your situation.
What is Minimum Essential Coverage?
Minimum Essential Coverage (MEC) is health coverage that meets federal standards. All Marketplace plans count as MEC. So do most job-based plans, Medicare, Medicaid and CHIP. Short-term plans and fixed indemnity plans do not count.
How are premiums set?
For ACA plans, insurance companies can't charge you more because of your health or your gender. They can only use these factors:
- Who is covered. A plan for one person usually costs less than a plan for a family.
- Where you live. Prices vary by area.
- Tobacco use. Tobacco users can be charged up to 50% more, where state law allows.
- Age. Older adults can be charged up to 3 times as much as younger adults.
- Plan category. Bronze, Silver, Gold and Platinum plans split costs differently between your monthly premium and what you pay when you get care.
Can I get help paying for a plan?
Maybe. It depends on your income and household size.
- Premium tax credit. For 2027 coverage, this is generally available if your household income is between 100% and 400% of the federal poverty level. That’s about $15,960 to $63,840 for one person, or $33,000 to $132,000 for a family of four (48 states and D.C.; limits are higher in Alaska and Hawaii). In states that expanded Medicaid, adults with income up to about 138% of the poverty level usually qualify for Medicaid instead of a tax credit. The extra savings that were available through 2025 have ended. Above 400%, there is no tax credit for 2027 unless Congress changes the law.
- Extra savings on Silver plans. If your income is up to 250% of the poverty level, a Silver plan may have lower deductibles and copays.
- Medicaid and CHIP. Your household may qualify for free or low-cost coverage. Income limits depend on your state.
Low or no income doesn’t automatically mean free coverage. Medicaid rules depend on your state, and in states that haven’t expanded Medicaid, many adults with very low income don’t qualify. The premium tax credit generally starts at 100% of the poverty level. Even a $0-premium plan can still have deductibles, copays and coinsurance when you get care. Your expected income, household, state and immigration status all matter, so an agent can help you see what you actually qualify for.
If you take the tax credit in advance, report income changes during the year. Starting with 2026 coverage, there is no limit on how much extra credit you may have to pay back at tax time.
Is there a penalty for not having health insurance?
There is no federal penalty. It has been $0 since 2019.
Some states have their own rules and may charge a penalty on your state taxes if you go without coverage:
- California
- Massachusetts
- New Jersey
- Rhode Island
- District of Columbia
Vermont also requires coverage but does not charge a penalty. Rules and amounts vary, so check your state's tax agency or ask a licensed agent.
Can I get an exemption from a state penalty?
In states with a penalty, you may qualify for an exemption. Common examples include:
- A short gap in coverage (usually less than 3 months in a row; Massachusetts uses 63 days)
- Income below the tax filing threshold
- Coverage would cost more than a set share of your income
- Membership in a federally recognized tribe
- Certain religious groups
- Time spent in jail or prison
- Hardships such as eviction, natural disaster or large medical debt
Each state decides its own exemptions. Check with your state.
What is a Qualifying Life Event?
A Qualifying Life Event is a big change that can let you enroll or switch plans outside Open Enrollment. This is called a Special Enrollment Period. Examples include:
- Getting married
- Having a baby, adopting a child, or having a foster child placed with you
- Losing other health coverage, such as job-based coverage, COBRA, Medicaid or CHIP
- Moving to a new ZIP code or county
You usually have 60 days after the event to pick a plan. If you lose Medicaid or CHIP, you have 90 days. Some events, like marriage and most moves, require that you had qualifying coverage before the event. Also report changes in income or household size, so your savings stay accurate and you avoid surprises at tax time.
What if I'm pregnant?
Under federal rules, pregnancy alone does not open a Special Enrollment Period. A few states do allow it, so check with your state's Marketplace. Having a baby does open one. You have 60 days after the birth to enroll or change plans, and the baby's coverage can start on the day of birth.
All Marketplace plans cover prenatal care, labor and delivery, and newborn care. A plan can't turn you down or charge you more because you are pregnant.
Medicaid covers pregnant people and newborns in every state, and some states also cover pregnancy through CHIP. Income limits vary, and you can apply any time of year.
What if I already have a private plan and get pregnant?
ACA plans for individuals and small businesses must cover maternity and newborn care. Most large employer plans also cover pregnancy. Some plans don't have to, including older "grandfathered" individual plans, short-term plans and fixed indemnity plans. If you have one of these, it may be worth comparing options.
What if I'm getting married?
Marriage is a Qualifying Life Event. You have 60 days after the wedding to enroll or change your Marketplace plan. At least one of you must have had qualifying health coverage for at least one day in the 60 days before the wedding. (There are exceptions, for example if you lived outside the U.S.) If you pick a plan by the end of the month, coverage usually starts the first day of the next month.
What if I lose my current coverage?
Losing health coverage is one of the most common reasons people qualify for a Special Enrollment Period. This includes coverage from a job, COBRA, Medicaid or CHIP, or an individual plan.
- You can enroll from 60 days before to 60 days after the loss. For Medicaid or CHIP, you have up to 90 days after.
- If your plan year is ending and it doesn't follow the calendar year, the renewal date also counts.
- Dropping coverage on purpose, or losing it because you didn't pay, does not qualify. You would need to wait for Open Enrollment.
How do I enroll in a Marketplace plan?
You can enroll on your own at HealthCare.gov or your state's Marketplace, or get help from a licensed agent like us. There are four ways to apply:
- Online. Create an account, fill out the application, see your savings, compare plans and enroll. Then pay your first premium to the insurance company to start coverage.
- By phone. Apply with the Marketplace call center or a licensed agent.
- By mail. Send a paper application, then finish enrolling online or by phone.
- In person. Navigators, certified assisters and licensed agents can help you face to face. Find local help at HealthCare.gov or your state's Marketplace.
Last reviewed October 2026. Rules can change and can vary by state; this page is general information, not legal or tax advice.