Question 1

What is the ACA Marketplace?

Accepted Answer

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.

Question 2

When is ACA open enrollment 2025-2026?

Accepted Answer

ACA open enrollment runs from November 1, 2025 through January 15, 2026. Plans selected by December 15 take effect January 1. Plans selected January 1–15 take effect February 1. Outside this window, you can only enroll if you have a qualifying life event that triggers a Special Enrollment Period (SEP).

Question 3

Can I get health insurance outside of open enrollment?

Accepted Answer

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.

Question 4

Does Policymage cover all 50 states?

Accepted Answer

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

Question 5

How do I qualify for an ACA subsidy?

Accepted Answer

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 2025: a single person earning up to $60,240 qualifies; a family of 4 earning up to $124,800 qualifies. Some lower-income households may qualify for $0/month Silver plans. Use the Policymage compare tool to see your estimated subsidy.

Question 6

What is APTC (Advance Premium Tax Credit)?

Accepted Answer

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.

Question 7

What is Cost-Sharing Reduction (CSR)?

Accepted Answer

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.

Question 8

What are the 2025 Federal Poverty Level income limits for ACA subsidies?

Accepted Answer

For 2025 ACA subsidies: 1 person — $15,060 (100% FPL) to $60,240 (400% FPL). 2 people — $20,440 to $81,760. 3 people — $25,820 to $103,280. 4 people — $31,200 to $124,800. 5 people — $36,580 to $146,320. Alaska and Hawaii have higher FPL thresholds. Households above 400% FPL may still qualify for subsidies if ACA premiums would exceed 8.5% of their income.

Question 9

What is the difference between Bronze, Silver, Gold, and Platinum health insurance?

Accepted Answer

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 — the only tier eligible for CSR subsidies. Gold (80% AV): higher premium, lower cost-sharing — better if you use healthcare frequently. Platinum (90% AV): highest premium, lowest cost-sharing. Choose based on how much care you expect to use.

Question 10

Is Silver health insurance the best choice?

Accepted Answer

Silver plans are the most popular tier because they qualify for Cost-Sharing Reductions (CSR) for income-eligible households, making them potentially much cheaper than they appear. If your income is between 100%–250% FPL, a Silver plan with CSR can have a deductible as low as $0 and out-of-pocket maximum as low as $1,600. If you don't qualify for CSR, compare Silver vs. Gold plans based on total expected cost (premium × 12 + expected deductible and copay spending).

Question 11

What is a Catastrophic health insurance plan?

Accepted Answer

Catastrophic plans have very low monthly premiums but very high deductibles (equal to the ACA out-of-pocket maximum, $9,200 for 2025). 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.

Question 12

What is the difference between an HMO and a PPO?

Accepted Answer

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.

Question 13

What is an EPO health insurance plan?

Accepted Answer

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.

Question 14

What is a POS health insurance plan?

Accepted Answer

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.

Question 15

What is a health insurance deductible?

Accepted Answer

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.

Question 16

What is an out-of-pocket maximum?

Accepted Answer

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 2025, the ACA out-of-pocket maximum is $9,200 for individuals and $18,400 for families. This limit does not include your monthly premium.

Question 17

What is the difference between a copay and coinsurance?

Accepted Answer

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.

Question 18

What is an HSA-eligible health insurance plan?

Accepted Answer

An HSA-eligible plan is a High-Deductible Health Plan (HDHP) that qualifies you to open and contribute to a Health Savings Account (HSA). To qualify in 2025, the plan must have a minimum deductible of $1,650 (individual) or $3,300 (family), and an out-of-pocket maximum no higher than $8,300 (individual) or $16,600 (family). HSA plans are marked on Policymage with an 'HSA' badge.

Question 19

What are the 2025 HSA contribution limits?

Accepted Answer

For 2025, the IRS HSA contribution limits are: $4,300 for self-only (individual) coverage, and $8,550 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.

Question 20

Can I use HSA funds for non-medical expenses?

Accepted Answer

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.

Question 21

How accurate are the premiums shown on Policymage?

Accepted Answer

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 /compare 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 the CMS federal marketplace API and HealthSherpa, the same sources used by HealthCare.gov.

Question 22

Does Policymage sell my information to insurance companies?

Accepted Answer

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 federal marketplace APIs. Household details are stored temporarily in your browser's session storage and are never stored on our servers.

Question 23

How do I enroll in a plan I found on Policymage?

Accepted Answer

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.

Health Insurance FAQ

ACA Basics

Subsidies & Costs

Metal Tiers

Plan Types (Networks)

Costs Explained

HSA Plans

Using Policymage