Bronze
~60% of costs covered
Lowest monthly cost, highest deductible. Sensible if you are healthy, hold savings you could tap, and mainly want protection against catastrophe.
What the Marketplace actually is
The Marketplace is a regulated shopping platform, not an insurance company. Private carriers file their plans and their prices with the state, the state approves them, and those plans appear side by side under one set of rules. Every plan sold there has to cover the same ten categories of essential care, cap what you can be asked to pay in a year, and accept you regardless of health history.
That standardization is the point. Before it existed, a carrier could review your medical file, decline you, or write an exclusion around the exact condition you needed treated. Today an application asks your household size, your income, your zip code, and your tobacco use. It does not ask what happened to you last year.
Who it is built for
If you are self-employed, contracting, between jobs, working somewhere that offers no benefits, retiring before 65, or aging off a parent's plan, the Marketplace is almost certainly your route to real coverage. It also matters for families whose employer plan covers the worker affordably but prices dependents out of reach.
Who is eligible to enroll
Marketplace coverage requires lawful presence in the United States. That includes citizens and nationals, lawful permanent residents holding a green card, people with valid work authorization or an employment authorization document, refugees and asylees, holders of certain visas, and applicants whose lawful-status case is pending with a recognized category. If your paperwork is mid-process, do not assume you are excluded, several pending statuses qualify, and eligibility is determined case by case.
You also cannot be enrolled in Medicare or incarcerated, and you must live in the state whose exchange you are applying through. There is no minimum income requirement to buy a plan, income only affects how much financial help you receive. Tell us your status when we speak and we will tell you plainly, in the first conversation, whether the Marketplace is open to you and what documentation the application will ask for.
Where the money comes from
Two separate forms of help exist, and they behave differently. The premium tax credit lowers what you pay each month, and you can take it in advance so it applies to every bill instead of arriving as a refund. Cost-sharing reductions do something else entirely: they shrink your deductible, copays, and out-of-pocket maximum. They only attach to Silver plans, and only below a certain income. Miss that detail and you can pay more for a Bronze plan than a Silver one would have cost you over a year of actual care.
The mistake we fix most
Choosing the cheapest premium on the screen.
A Bronze plan can look like a bargain in November and cost you thousands in March. If you qualify for cost-sharing reductions, a Silver plan often has a lower premium and a smaller deductible. We run both numbers against how you actually use care before you sign anything.
Have someone check my math →What changed this year
The subsidy rules changed. Most people have not been told.
The enhanced subsidies that ran from 2021 through 2025 expired on 31 December 2025 and were not renewed. Three things follow from that, and together they make this the wrong year to auto-renew whatever you had.
The cliff came back
Help now stops dead at 400% of the federal poverty level. One dollar over and the credit is not reduced, it is zero.
Everyone pays more
The share you are expected to contribute rose at every income level, so the same plan costs more than it did last year.
No repayment cap
Estimate your income too low and the entire advance credit is repayable at filing. Getting the estimate right matters more than it ever has.
What the income limits actually are
Financial help runs from 100% to 400% of the federal poverty level. In plain figures, for the 2026 plan year in the contiguous states, that is roughly $15,650 to $62,600 for a single person and $32,150 to $128,600 for a household of four. Alaska and Hawaii use higher tables.
Two things people get wrong. There is no minimum income to buy a plan, only to receive help. And if you are sitting near the upper line, where you land changes the outcome dramatically, which is a planning conversation rather than a guess.
Not sure which side of the line you fall on?
Tell me your household size and I will place you →
Where you live
Available everywhere, identical nowhere
Marketplace coverage exists in all fifty states, but how you reach it and what you find there depends on where you live. Three differences matter enough to change a decision.
Two different platforms
Twenty-one states and DC run their own exchange, with names like Covered California, NY State of Health and Pennie. The rest use HealthCare.gov.
Deadlines are not uniform
Most states close on 15 January. Several state exchanges, California and New York among them, run later. Assuming the national date is how people miss their window.
Four places run something else
Minnesota, New York, Oregon and DC operate their own program for lower incomes instead of Marketplace plans. If you live there, that is checked first.
Rules, deadlines and carriers all turn on your state.
Tell me where you live →
The four tiers, translated
Tiers describe how costs are split between you and the carrier, not the quality of the medicine. A Bronze plan and a Platinum plan at the same company often use the identical doctor network.
Silver
~70% of costs covered
The only tier that unlocks cost-sharing reductions. For eligible households this is frequently the best value on the entire exchange, better coverage for less money.
Most chosen
Gold
~80% of costs covered
Higher premium, much lower deductible. The right call when you take regular medication, see specialists, or expect a procedure this year.
Platinum
~90% of costs covered
Richest benefits, steepest premium, and not offered in every market. Worth pricing when ongoing treatment is a certainty rather than a possibility.
Silver or Gold is decided by your income, not your budget.
Tell me what you expect to earn →
When you are allowed to enroll
Marketplace coverage is not available year-round, and that catches people off guard. Open Enrollment runs from November 1 to January 15 in most states, with a handful of state exchanges extending further. Enroll by December 15 and coverage typically begins January 1; enroll after that and it usually starts February 1.
Open Enrollment is not your only door, though, and this is the part most people never hear. A Special Enrollment Period opens a private window just for you whenever your life changes in a way the law recognizes. Leave a job or get laid off and lose the coverage that came with it, move to a new county or state, get married or divorced, have a baby, adopt, turn 26 and age off a parent's plan, see your household income shift enough to change what you qualify for, or gain lawful status, any one of these lets you enroll for the first time or switch from the plan you already have to one that fits better.
You generally have 60 days from the qualifying event to act, and some events allow you to apply in the 60 days beforehand so coverage starts without a gap. Miss the window and you wait until the next Open Enrollment, which is why the day you learn your situation is changing is the day to make the call, not the day it takes effect.
Events that open a 60-day window
- Losing job-based or student coverage
- Marriage or divorce
- Birth, adoption, or foster placement
- Permanent move to a new coverage area
- Turning 26 and leaving a parent's plan
- A household income change affecting eligibility
- Gaining citizenship or lawful presence
Missed Open Enrollment? A qualifying event opens a 60-day window.
Tell me what changed recently →
Why work with us
The plan costs the same. The guidance is what changes.
Carrier prices are filed with the state, so nobody can discount them and nobody can inflate them. Enrolling with an advisor is free, and it is the difference between picking a plan and understanding one.
What it costs you
Nothing. Prices are filed with your state.
Nobody can discount a filed rate and nobody can inflate it. The only variable is whether someone who knows the market is sitting on your side of the table.
We check your doctors first
Before you enroll, we verify your physicians and prescriptions against each plan's network and formulary. Nobody should discover a gap at the pharmacy counter.
Subsidies calculated properly
Self-employed income, variable hours, mid-year changes, these are where estimates go wrong and refunds get clawed back. We model it carefully, on paper, with you.
Someone answers next year
A denied claim, a renewal that jumped, a plan leaving your county. You call the same office that enrolled you, not a queue.
The part people regret
Check the network before the price
Most Marketplace plans are HMO or EPO designs, which means care outside the network is generally not covered at all except in a true emergency. Many networks are built around a single regional hospital system, so two plans that look alike on price can be entirely different in practice.
The same applies to medication. Every plan carries its own formulary, and a drug covered cheaply on one can be expensive or excluded on another. Both are checked before you enrol, never after.
Have doctors or prescriptions you want to keep?
Give me the names and I will have them checked →
Questions we hear daily
ACA Marketplace, answered plainly
Can I be denied ACA coverage for a pre-existing condition?+
No. Marketplace plans cannot deny you, charge you more, or write an exclusion because of your medical history. That protection is absolute and it applies from the first day of coverage, including to a pregnancy that already exists when you enroll.
When can I enroll in an ACA Marketplace plan?+
Open Enrollment runs November 1 through January 15 in most states, and some state-run exchanges extend beyond that. Outside the window you need a Special Enrollment Period, triggered by an event such as losing job-based coverage, moving, marriage, divorce, or the birth or adoption of a child. You usually have 60 days from that event to enroll.
How do premium tax credits actually work?+
The credit is based on your household size, your projected income for the coverage year, and the cost of plans where you live. Most people take it in advance, so the money goes straight to the carrier and lowers every monthly bill. Because it is reconciled on your tax return, estimating income honestly matters, under-report and you may owe some back, over-report and you leave savings on the table.
Which metal tier should I choose?+
It depends far less on your budget than people assume. Bronze trades a low premium for a high deductible. Silver is the only tier that unlocks cost-sharing reductions, which is why it is often the best total value for lower and middle incomes, sometimes a better plan for less money than Bronze. Gold and Platinum cost more each month but pay far more when you actually use care, which suits ongoing treatment or planned procedures.
Does working with a MaliCare advisor cost me anything?+
Nothing. Carrier premiums are filed with and approved by your state, so the same plan costs the same whether you enroll alone, through the exchange, or with us. The only variable is whether someone knowledgeable is sitting on your side of the table.
What happens if my doctor is not in the plan network?+
Most Marketplace plans are HMO or EPO designs, which means out-of-network care is generally not covered outside a true emergency. This is the single most common source of regret, and it is entirely preventable, we check your physicians and prescriptions against each plan before you sign.
Can I keep my plan if my income changes mid-year?+
Yes, and you should report the change promptly. A raise or a slow quarter can move your subsidy in either direction. Reporting it adjusts your credit going forward instead of creating a surprise at tax time, and a significant change can even open a Special Enrollment Period to switch plans.
Is Marketplace coverage the same as Medicaid?+
No. Medicaid is a state and federal program with its own income thresholds and, in most states, no premium. Marketplace plans are private insurance with premiums that subsidies help offset. When we run your numbers, we tell you which program you fall under, including if Medicaid or CHIP would serve your family better.
Do I need to be a citizen to get a Marketplace plan?+
No, but you do need lawful presence in the United States. Citizens, green card holders, people with work authorization, refugees and asylees, certain visa holders, and applicants with a pending case in a recognized category can all qualify. If your paperwork is still in process, ask before assuming you are shut out, several pending statuses are eligible, and we can confirm yours in one conversation.
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ACA Marketplace Program
Four quick questions. Nothing here is a commitment, and we do not need personal details yet.
Income sets your financial help. There is no wrong answer here.
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