Health (Marketplace)
ACA plans are the major medical coverage you buy on your own through the Marketplace. If your income qualifies, a subsidy lowers what you pay each month. Here is how it works and who it fits.
What it covers
- What it pays for
- Full major medical: hospital stays, doctor visits, preventive care, and prescriptions, with no denial for pre-existing conditions.
- How it works
- Bronze, Silver, Gold, and Platinum. Lower tiers cost less each month but leave more for you to pay when you get care.
- Who it suits
- Individuals and families with no plan through work, especially if your income qualifies you for a subsidy.
What it costs
A monthly premium, then a deductible before the plan pays its share, plus copays and coinsurance up to a yearly out-of-pocket cap.
Hawkins Insurance Group, LLC is not connected with or endorsed by the United States government, the federal Medicare program, or the Health Insurance Marketplace (healthcare.gov). Plan availability and any premium tax credits depend on your household and are estimates until confirmed by the Marketplace at HealthCare.gov.
What is good about it
- Covers big, unexpected medical bills
The catch
- Full price is expensive above the subsidy cliff
- You can usually only switch during Open Enrollment
Common questions
- ACA (Affordable Care Act) coverage is sold on the federal Marketplace, sometimes called Obamacare. You qualify if you are a citizen or lawful resident, not incarcerated, and do not have coverage through work. Open Enrollment runs November 1 to January 15 each year. Your income decides whether you get a premium tax credit.
- The subsidy cliff is 400% of the federal poverty level. If your household earns above it, you get no Marketplace subsidy in 2026, because the larger pandemic-era credits expired January 1, 2026. Above the cliff, Affordable Choice may cost less than full-price ACA.
- Silver adds extra cost help if your income is below 250% of poverty level. Gold and Platinum cost more each month but pay more when you get care. Add up (premium times 12) plus the care you expect, and pick the smaller total.