All Answers

• What is the Premium Tax Credit?

  The Premium Tax Credit (PTC) is a refundable federal tax credit that lowers what you pay for a Health Insurance Marketplace plan, either applied in advance to reduce your monthly premium or claimed on your tax return via Form 8962, per the IRS (2026).

• What income counts for ACA subsidies?

  ACA subsidies use Modified Adjusted Gross Income (MAGI): your adjusted gross income plus any tax-exempt interest, non-taxable Social Security benefits, and excluded foreign income, added together for everyone in your tax household, per IRS (2026).

• What happens if my income changes during the year?

  If your income changes during the year you should update your Marketplace application right away, because your Premium Tax Credit is based on estimated annual income and must be reconciled on IRS Form 8962 at tax time — meaning you may owe money back or receive a larger credit, according to HealthCare.gov and IRS (2026).

• Can I have Marketplace coverage and Medicare at the same time?

  You should not keep a Marketplace plan with a Premium Tax Credit once you are eligible for premium-free Medicare Part A, because the Marketplace generally will not pay the tax credit for months you are enrolled in Medicare, per HealthCare.gov (2026); this site covers only the under-65 Marketplace — Medicare-specific questions live on a separate property.

• What is a Marketplace Navigator?

  A Marketplace Navigator is a trained, unbiased person or organization funded to help consumers understand their coverage options and complete a Marketplace application at no cost to the consumer, per CMS (2026); Navigators do not sell insurance.

• How are ACA premiums calculated?

  ACA plan premiums are calculated using only five allowed factors — age, ZIP code (rating area), tobacco use, individual vs family enrollment, and plan category — with no rating for gender or pre-existing conditions, per HealthCare.gov (2026).

• When is Open Enrollment for 2026?

  Open Enrollment for 2026 Marketplace coverage on HealthCare.gov runs from November 1, 2025 through January 15, 2026 in most states, with coverage starting January 1, 2026 for enrollments completed by December 15, 2025, per HealthCare.gov (2026); state-based Marketplaces may set slightly different dates.

• How much does Marketplace insurance cost?

  The cost of Marketplace insurance depends on your age, plan metal level, tobacco use, ZIP code, and household size, but most enrollees pay a net premium below the full sticker price because the Premium Tax Credit lowers what they owe each month, according to HealthCare.gov (2026).

• What is Obamacare?

  "Obamacare" is the informal nickname for the Affordable Care Act (ACA), the 2010 U.S. federal law that created the Health Insurance Marketplace, subsidized coverage through the premium tax credit, and prohibited insurers from denying coverage for pre-existing conditions, per HealthCare.gov (2026).

• Can immigrants get ACA Marketplace coverage?

  Lawfully present immigrants can buy a Marketplace plan and, if their income qualifies, receive the Premium Tax Credit; U.S. citizens, U.S. nationals, and lawfully present immigrants are eligible to use HealthCare.gov, but undocumented immigrants are not, per HealthCare.gov (2026).

• Can I stay on my parents' health plan until 26?

  Yes — under the ACA, if a health plan covers children it must let dependents stay on the plan until age 26, whether or not they are married, living at home, in school, or financially dependent, according to HealthCare.gov (2026).

• Are pre-existing conditions covered under the ACA?

  Yes — under the Affordable Care Act, Marketplace health plans and most employer plans cannot deny coverage, charge more, or refuse to pay for essential health benefits because of a pre-existing condition, according to HealthCare.gov (2026).

• Do I pay a penalty for not having health insurance?

  There is no federal tax penalty for going without health insurance starting with the 2019 tax year, because the ACA's individual shared-responsibility payment was reduced to $0 by federal law, per HealthCare.gov and IRS (2026), though a handful of states impose their own penalty.

• Who qualifies for ACA subsidies?

  You generally qualify for ACA subsidies if you buy a plan through the Marketplace, are not eligible for other qualifying coverage (such as Medicare, Medicaid, or affordable job-based coverage), and your household income falls within the ranges the Marketplace uses to calculate the Premium Tax Credit, according to HealthCare.gov and IRS (2026).

• Can I get ACA coverage if my employer offers insurance?

  You can buy a Marketplace plan even if your employer offers insurance, but you generally only qualify for a Premium Tax Credit if the employer coverage is considered unaffordable or does not meet minimum value under the IRS affordability rule for 2026, per HealthCare.gov and IRS (2026).

• ACA vs Medicaid — which do I qualify for?

  If your household income is at or below your state's Medicaid limit you generally qualify for Medicaid instead of a subsidized Marketplace plan; if your income is above that limit you likely qualify for a Marketplace plan with a Premium Tax Credit, according to HealthCare.gov (2026), and the exact cut-off depends on whether your state expanded Medicaid.

• COBRA vs Marketplace — which is better?

  COBRA lets you keep your former employer's plan for up to 18 months but you pay the full premium plus a small admin fee, while a Marketplace plan is a fresh ACA-qualified plan that may cost less because you can receive the Premium Tax Credit, according to HealthCare.gov (2026); losing job-based coverage opens a 60-day Special Enrollment Period.

• How do I apply on HealthCare.gov?

  To apply on HealthCare.gov you create an account, submit a Marketplace application with your household size and estimated 2026 income, review your eligibility results for a Premium Tax Credit or Medicaid, then compare plans and enroll, per HealthCare.gov (2026).

• What is a Special Enrollment Period?

  A Special Enrollment Period (SEP) is a window outside Open Enrollment when you can enroll in or change a Marketplace plan because of a qualifying life event such as losing other coverage, getting married, having a baby, or moving, per HealthCare.gov (2026); you usually have 60 days from the event to enroll.

• What is a Qualified Health Plan?

  A Qualified Health Plan (QHP) is a health insurance plan that is certified by a Marketplace, covers essential health benefits, follows established limits on cost-sharing, and meets other ACA requirements, per HealthCare.gov (2026); only QHPs are eligible for the Premium Tax Credit.

• What is Minimum Essential Coverage?

  Minimum Essential Coverage (MEC) is any health coverage that satisfies the ACA's definition of qualifying coverage, including Marketplace plans, most employer plans, Medicare, Medicaid, CHIP, TRICARE, and certain other government programs, per IRS (2026).

• What is Form 1095-A?

  Form 1095-A, Health Insurance Marketplace Statement, is the document the Marketplace sends you each January if anyone in your household had a Marketplace plan the previous year, and you use it to reconcile your Premium Tax Credit on IRS Form 8962 when you file taxes, per IRS (2026).

• What are essential health benefits?

  Essential Health Benefits (EHBs) are the 10 categories of care every ACA-qualified Marketplace plan must cover, including ambulatory care, emergency services, hospitalization, maternity and newborn care, mental health and substance-use services, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services, and pediatric services including dental and vision, per HealthCare.gov (2026).

• Do Marketplace plans cover mental health and substance use?

  Yes — ACA-qualified Marketplace plans must cover mental health and substance-use disorder services as essential health benefits, and federal parity rules require these benefits to be no more restrictive than comparable medical and surgical benefits, per HealthCare.gov (2026).

• Do Marketplace plans cover preventive care?

  Yes — ACA-qualified Marketplace plans must cover a defined list of preventive services (such as recommended vaccines, screenings, and annual wellness visits) at no cost to you when delivered by an in-network provider, per HealthCare.gov (2026).

• Does the Marketplace cover dental and vision?

  ACA Marketplace medical plans must cover pediatric dental and vision as essential health benefits, but adult dental and vision are typically sold as separate stand-alone dental plans on HealthCare.gov and are not part of the base medical plan, per HealthCare.gov (2026).

• What do Bronze, Silver, Gold, and Platinum plans cover?

  All ACA metal-level plans cover the same set of essential health benefits, but Bronze pays about 60%, Silver about 70%, Gold about 80%, and Platinum about 90% of average total costs, with the remainder paid by the enrollee through deductibles, copays, and coinsurance, according to HealthCare.gov (2026).

• What is actuarial value in ACA plans?

  Actuarial value is the share of average medical costs an ACA plan is expected to pay across a standard population — roughly 60% for Bronze, 70% for Silver, 80% for Gold, and 90% for Platinum plans on the Marketplace, per HealthCare.gov (2026).

• What is catastrophic health coverage on the Marketplace?

  A catastrophic plan is a low-premium, high-deductible ACA Marketplace plan available to people under 30 or those with an approved hardship or affordability exemption; it covers essential health benefits and 3 primary-care visits per year before the deductible, per HealthCare.gov (2026), but is not eligible for the Premium Tax Credit.

• What is a Cost-Sharing Reduction?

  A Cost-Sharing Reduction (CSR) is an extra ACA discount that lowers your deductible, copays, coinsurance, and out-of-pocket maximum, and you can only get it by enrolling in a Silver Marketplace plan and having qualifying household income, per HealthCare.gov (2026).

• What is the out-of-pocket maximum on an ACA plan?

  The out-of-pocket maximum is the most you have to pay for covered in-network services in a plan year — once you hit it, the plan pays 100% of covered essential health benefits for the rest of the year, per HealthCare.gov (2026); the ACA sets an upper limit on this amount each year.

• What is a copay on a health insurance plan?

  A copay is a fixed dollar amount you pay for a covered health care service, such as $30 for a primary-care visit, and it usually applies whether or not you have met your deductible, per HealthCare.gov (2026).

• What is a deductible on a health insurance plan?

  A deductible is the amount you pay for covered health care services before your ACA plan starts to pay — for example, with a $2,000 deductible you pay the first $2,000 of covered care yourself, then cost-sharing begins, per HealthCare.gov (2026).

• What is coinsurance on a health insurance plan?

  Coinsurance is the percentage of the cost of a covered health service you pay after you have met your deductible — for example, with 20% coinsurance on a $200 covered service you pay $40 and the ACA plan pays $160, per HealthCare.gov (2026).

• Can I keep my doctor on a Marketplace plan?

  You can keep your doctor only if that doctor is in the network of the specific Marketplace plan you enroll in, because ACA plans use provider networks and out-of-network care is usually paid in full by the enrollee, according to HealthCare.gov (2026).

• What is the ACA?

  The ACA is the Affordable Care Act, a 2010 U.S. federal health-insurance law that created the Health Insurance Marketplace, made premium tax credits available to eligible households, and requires most plans to cover pre-existing conditions, according to HealthCare.gov (2026). Often called Obamacare, it was signed into law in 2010 and shapes which plans you can buy, what they must cover, and whether you qualify for financial help.