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How Marketplace health plans work

The Health Insurance Marketplace is where individuals and families buy private health plans. Here's the plain-English version of what that means for you.

What the Marketplace actually is

The Health Insurance Marketplace was created by the Affordable Care Act (the ACA, sometimes called "Obamacare"). It's a place where you can shop for private health insurance from real insurance companies — the same carriers you already know.

Plans are sold by private insurers, not the government. An agency like CoverageCo helps you compare those plans and enroll. (CoverageCo is a private, licensed agency — we are not affiliated with or endorsed by any government agency.)

Who it's for

Marketplace plans are built for people who don't get affordable coverage another way — for example, if you're self-employed, between jobs, a gig worker, an early retiree under 65, or your employer's plan is too expensive.

If you're 65 or older you'll generally look at Medicare instead. Marketplace coverage is for under-65 individuals and families.

What every plan has to cover

By law, every Marketplace plan covers a core set of "essential health benefits." No plan can leave these out, and they can't deny you or charge you more for a pre-existing condition.

  • Doctor visits and outpatient care
  • Emergency services and hospital stays
  • Prescription drugs
  • Maternity, newborn, and pediatric care (including dental and vision for kids)
  • Mental health and substance-use treatment
  • Preventive care and chronic-disease management — many preventive services are covered at no extra cost
  • Lab work and rehabilitation services

Where an agent fits in

You can shop on your own — but the plans differ in networks, drug coverage, and out-of-pocket costs in ways that aren't obvious. A licensed agent compares your real options, checks that your doctors and prescriptions are covered, and handles the paperwork. It costs you nothing extra.

Talk it through

Have a real person explain your options.

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