Health Insurance FAQ

The ACA (Affordable Care Act) Marketplace, also called the Health Insurance Exchange, is where Americans can shop for, compare, and enroll in ACA-compliant health insurance plans. Most states use the federal marketplace at HealthCare.gov. Some states (California, New York, Washington, and others) run their own state-based exchanges.

On HealthCare.gov, open enrollment for 2027 coverage runs from November 1, 2026 through January 15, 2027. Plans selected by December 15 take effect January 1; plans selected January 1 to 15 take effect February 1. States that run their own exchange set their own dates, and some open earlier or close later, so check your state's page. Outside this window, you can only enroll if you have a qualifying life event that triggers a Special Enrollment Period (SEP).

Yes, through a Special Enrollment Period (SEP). Qualifying life events include: losing job-based coverage, getting married or divorced, having a baby or adopting a child, moving to a new county or state, gaining citizenship, or leaving incarceration. You generally have 60 days from the qualifying event to enroll.

Yes. Policymage covers all 50 states and Washington DC. States using HealthCare.gov (like Texas, Florida, Ohio) are served via the federal marketplace. States with their own exchanges (like California's Covered California and New York's NY State of Health) are served via state-based marketplaces.

To qualify for an Advance Premium Tax Credit (APTC), your household income must be between 100% and 400% of the Federal Poverty Level (FPL). For 2027: a single person earning up to $63,840 qualifies; a family of 4 earning up to $132,000 qualifies. Above 400% FPL there is no credit, because the enhanced rules that removed that limit expired after 2025. Some lower-income households qualify for $0/month Bronze plans. Use the Policymage compare tool to see your estimated subsidy.

Before subsidies, the cheapest Bronze plan for a 40-year-old costs a median of $433 a month across the 50 states and DC at 2026 rates, from $283 in Maryland to $824 in Vermont (near each state's largest city; prices rise with age). Most buyers pay far less after the premium tax credit, which depends on income: see the next answer, and the state-by-state table on our affordable health insurance page.

Often, yes. At 150% of the poverty line ($23,940 a year for one person), the tax credit covers the whole cheapest Bronze plan for a 40-year-old in 43 of the 50 states and DC at 2026 rates. Below 138% of the poverty line, Medicaid is free in states that expanded it. A $0 Bronze plan still has a high deductible, so compare it with a Silver plan with cost-sharing reductions if your income is under 250% of the poverty line. Our $0 health insurance by state page lists the income limit for a $0 plan in every state.

For 2027 coverage, the share of income you are expected to pay for the benchmark Silver plan runs from 2.15% to 10.22% (it was 2.10% to 9.96% in 2026), so the same household pays slightly more; the federal out-of-pocket maximum is $12,000 for one person and $24,000 for a family ($10,600 and $21,200 in 2026); the HSA contribution limit is $4,500 for self-only and $9,000 for family coverage ($4,400 and $8,750 in 2026). The poverty guidelines used for 2027 plans are the 2026 ones, which set the 100% to 400% income range for the premium tax credit ($15,960 to $63,840 for one person). The enhanced subsidies that removed the 400% limit expired after 2025, so there is still no credit above it. Insurers also reprice plans every year: see your state page for 2027 prices once they are published.

The Advance Premium Tax Credit (APTC) is a federal subsidy that directly reduces your monthly health insurance premium. The subsidy amount is based on your household income relative to the Federal Poverty Level (FPL), your location, and the cost of the benchmark Silver plan in your county. You can take it in advance (applied monthly to your premium) or as a tax credit when filing your federal taxes.

Cost-Sharing Reduction (CSR) is an additional subsidy that lowers your deductible, copays, and out-of-pocket maximum. CSR is only available on Silver plans and only for households with income between 100%–250% of the Federal Poverty Level. CSR creates enhanced Silver plan variants (Silver 73, Silver 87, Silver 94) with significantly lower cost-sharing than a standard Silver plan.

For 2027 coverage, subsidies use the 2026 HHS poverty guidelines. 1 person: $15,960 (100% FPL) to $63,840 (400% FPL). 2 people: $21,640 (100% FPL) to $86,560 (400% FPL). 3 people: $27,320 (100% FPL) to $109,280 (400% FPL). 4 people: $33,000 (100% FPL) to $132,000 (400% FPL). 5 people: $38,680 (100% FPL) to $154,720 (400% FPL). Alaska and Hawaii have higher FPL thresholds. Above 400% FPL there is no premium tax credit in 2027.

ACA plans are categorized into metal tiers based on actuarial value (how much the plan pays on average for covered services). Bronze (60% AV): lowest premium, highest cost-sharing. Silver (70% AV): moderate premium, moderate cost-sharing, and the only tier eligible for CSR subsidies. Gold (80% AV): higher premium, lower cost-sharing when you use care. Platinum (90% AV): highest premium, lowest cost-sharing. To compare tiers, look at total annual cost (premium x 12 plus expected cost-sharing).

Silver is the only metal tier eligible for Cost-Sharing Reductions (CSR). If your household income is between 100% and 250% FPL, a Silver plan with CSR has reduced cost-sharing: the deductible can be as low as $0 and the out-of-pocket maximum as low as $1,600. Without CSR, a Silver plan has standard 70% AV cost-sharing. Total annual cost for any plan is premium × 12 plus expected deductible and copay spending.

Catastrophic plans have very low monthly premiums but very high deductibles (equal to the ACA out-of-pocket maximum, $12,000 for 2027). They cover 3 primary care visits per year before the deductible. Catastrophic plans are only available to people under 30, or adults of any age who qualify for a hardship or affordability exemption. They are not eligible for APTC subsidies.

HMO (Health Maintenance Organization): You choose a primary care physician (PCP) who coordinates your care. Referrals are required to see specialists. Coverage is limited to in-network providers except in emergencies. HMOs have lower premiums. PPO (Preferred Provider Organization): You can see any doctor or specialist without a referral. Out-of-network care is covered, but at a higher cost. PPOs have higher premiums but more flexibility.

An EPO (Exclusive Provider Organization) is a hybrid of HMO and PPO. Like an HMO, you must stay in-network (no out-of-network coverage except emergencies). Unlike an HMO, you typically don't need a referral to see a specialist. EPOs often have lower premiums than PPOs while offering more flexibility than HMOs.

A POS (Point of Service) plan combines HMO and PPO features. You need a primary care doctor and referrals for specialists (like an HMO), but you can also go out-of-network at a higher cost (like a PPO). POS plans are less common than HMOs and PPOs.

A deductible is the amount you pay out-of-pocket each year for covered health care services before your insurance starts paying. Example: If your deductible is $3,000, you pay the first $3,000 of covered medical bills yourself. After that, you typically pay only copays or coinsurance. Preventive care (annual checkups, vaccines) is usually free before meeting your deductible.

The out-of-pocket maximum (MOOP) is the most you'll pay for covered health care in a calendar year. Once you reach this limit, your insurance covers 100% of covered costs for the rest of the year. For 2027, the ACA out-of-pocket maximum is $12,000 for individuals and $24,000 for families. This limit does not include your monthly premium.

A copay is a fixed dollar amount you pay for a specific service (e.g., $30 for a primary care visit, $60 for a specialist). The amount stays the same regardless of the total bill. Coinsurance is your percentage share of costs after meeting your deductible (e.g., 20% coinsurance means you pay 20% and insurance pays 80%). Most plans use a combination of both.

An HSA-eligible plan is a High-Deductible Health Plan (HDHP) that qualifies you to open and contribute to a Health Savings Account (HSA). For 2027, the plan must have a deductible of at least $1,750 (individual) or $3,500 (family), and its out-of-pocket maximum must stay under the IRS limit for HDHPs. HSA plans are marked on Policymage with an 'HSA' badge.

For 2026, the IRS HSA contribution limits are: $4,400 for self-only (individual) coverage, and $8,750 for family coverage. People age 55 and older can contribute an additional $1,000 catch-up contribution. HSA contributions are tax-deductible, grow tax-free, and can be withdrawn tax-free for qualified medical expenses.

Yes, but with a penalty if you're under 65. Withdrawals for non-qualified expenses before age 65 are subject to income tax plus a 20% penalty. After age 65, you can withdraw HSA funds for any purpose and pay only ordinary income tax (no penalty), similar to a traditional IRA. Common qualified medical expenses include deductibles, copays, prescriptions, dental, and vision.

Premiums on state overview pages are estimates for a 30-year-old non-smoker without subsidies in a representative ZIP code. When you use the personalized /get-quotes tool with your actual age, household size, income, and ZIP code, premiums shown reflect your specific situation including any APTC subsidy. Plan data is sourced directly from official federal and state marketplaces, the same sources used by HealthCare.gov.

No. Policymage does not sell, share, or transmit your personal information to insurance companies, brokers, or third parties. The information you enter (ZIP code, age, income) is used only to fetch and display relevant plan data from public marketplace data. Household details are stored temporarily in your browser's session storage and are never stored on our servers.

Policymage is a comparison tool. We do not process enrollments. Once you've found a plan you want, click through to the official marketplace to complete enrollment. For most states, this is HealthCare.gov. For state-based exchange states (California, New York, Washington, etc.), you'll be directed to that state's exchange website.