What is the health insurance Marketplace?
The health insurance Marketplace (also known as the ACA Marketplace) is where you can purchase a health plan for you and your family. UnitedHealthcare offers a variety of Individual & Family ACA Marketplace plans. If plans are available in your area, you may be able to shop and enroll directly through UnitedHealthcare.
How do Marketplace plans work?
- Plans are categorized by “metal” levels — Bronze, Silver and Gold — that determine how you and your plan split the cost of care
- You may be able to qualify for savings, also called subsidies, that help lower health care costs (9 out of 10 people1 with ACA Marketplace plans qualify for savings)
- Most people sign up for a plan during open enrollment period, which runs November 1 to January 15 in most states
- If you experience a qualifying life event (like turning 26 or having a baby), you may be able to enroll outside of the open enrollment window
Ready to find the right ACA plan for you?
Understanding Bronze, Silver and Gold plan categories
All health plans available on the ACA Marketplace offer quality care that supports your health and wellbeing. Plans are organized into 3 categories — Bronze, Silver and Gold. Also called metal levels, these categories determine your cost of care and amount of coverage. They don’t impact the quality or type of care you’ll get. A wide range of UnitedHealthcare ACA plans are available in these 3 metal levels.
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Bronze
You may want to choose this plan if you rarely see your doctor. Bronze plans help with the cost of worst-case medical scenarios, like serious illness or injury. You’ll have a low monthly premium but pay more when you get care.
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Silver
If you typically just see your provider for routine preventive care, consider a Silver plan. You’ll pay a slightly higher monthly premium than Bronze plans, but you’ll get more coverage. Silver plans may also qualify for cost-sharing reduction savings.
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Gold
If you see your doctor often during the year, a Gold plan may be a good choice for you. You’ll pay a higher monthly premium each month but pay less when you get care.
Is an ACA Marketplace plan a good fit for you?
A UnitedHealthcare Individual & Family ACA Marketplace plan could be a good fit if:
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You’re new to buying your own health insurance
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You don’t get or don’t want health insurance through your employer
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You’re self-employed
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You’re not eligible for Medicare or Medicaid
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Your employer offers reimbursement to help cover the cost of a health plan you purchase
How can you save money on ACA plans?
Depending on your household income, you may qualify for low or even $0 health plans2, which can help make health coverage more affordable than you may expect. Over half of our members paid $0 monthly premium in 2024.1 Here are a few ways you may be able to save.
Premium tax credit
- Generally, the lower your household income, the larger your tax credit
- If you qualify, you can use some or all of the tax credit to help pay your premium, which can result in a low or $0 monthly cost2
- Premium tax credit is available for Bronze, Silver and Gold plan categories
- The tax credit is sent directly to your insurance company
Cost-sharing reduction (CSR)
- CSR is extra savings on top of the premium tax credit, if you qualify
- With a CSR, you pay less than you normally would for covered health benefits
- Available only on Silver plans, these discounts help you save on out-of-pocket spending by lowering costs like copays, coinsurance and deductibles
- You qualify for a CSR based on your income level
Does your employer offer ways to save?
Types of employer reimbursement
- Some employers offer reimbursement arrangements for employees to purchase coverage on their own through the ACA Marketplace
- This is instead of offering employer group health insurance benefits
- There are 2 types of reimbursements – Individual Coverage Health Reimbursement Arrangement (ICHRA) and Qualified Small Employer Health Reimbursement Arrangement (QSEHRA)
What to know about reimbursement
- Employers reimburse some or all of the premiums employees pay for health insurance they purchase on their own
- Typically, if you get an ACA Marketplace health plan with a reimbursement arrangement like ICHRA or QSEHRA, you won’t qualify for subsidies
- Because you won’t qualify for subsidies (savings), you’ll need to shop for an off-exchange ACA plan
Frequently asked questions
ACA Marketplace plans are health care plans that people can buy on their own, rather than through an employer or another government-run program, like Medicare or Medicaid. You might also hear names like Exchange plans and Individual & Family Plans. The ACA Marketplace (also called the Exchange) is where ACA health care plans are sold.
Under the American Rescue Plan Act of 2021 (ARPA) and Inflation Reduction Act of 2022, you may be able to enroll in ACA Marketplace coverage with lower premiums — and you can see if you qualify for financial subsidies. These subsidies could be tax credits or cost-sharing reductions to help pay for your health care costs.
A pre-existing condition is a health issue you had before your health plan starts. Under current law, companies offering ACA Marketplace health plans that meet minimum essential coverage requirements can't refuse to cover you or charge you more because of a pre-existing condition.
A copay (or copayment) is a fixed amount you may pay for a covered health care service, usually at the time you receive the service.
You might remember times when you went in for a doctor visit and maybe paid a $15 or $20 copay before or after your visit (copay amounts vary depending on the provider and service). That’s how copays work. With health plans that have copays (not all do), you’ll know what you have to pay ahead of time, which can help you budget your health care costs. For most plans, your copay does not apply toward your deductible.
Coinsurance is a percentage of the cost of a health care service, and it’s what you pay once you meet your deductible. A common coinsurance amount is 20%, but the cost-sharing percentages could be anything.
If your doctor visit costs $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20 out-of-pocket. Your insurance would then pay the rest of the allowed amount ($80) for covered health care services.
You might have heard terms like out-of-pocket max or limit. They mean the same thing. They each refer to the most you could pay during a 12-month coverage period for your share of the costs of covered services. Typically, deductibles, copays and coinsurance all count toward your out-of-pocket maximum. Things like your monthly premium or anything your plan doesn't cover (like out-of-network services) do not.
If you meet your out-of-pocket maximum, your plan will pay for 100% of your covered health care costs (up to the allowed amount). Let’s say you have an annual out-of-pocket maximum of $6,000. That means once you’ve paid $6,000 out-of-pocket for your covered health care, usually including deductibles, copays and coinsurance, your plan will cover any future (covered, in-network) health care services during your coverage period.