Marketplace health coverage

What every Marketplace plan covers

All Marketplace plans cover the same ten categories of essential health benefits:

• Outpatient care (ambulatory patient services)
• Emergency services
• Hospitalization
• Pregnancy, maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care for children

No Marketplace plan can turn you down or charge you more because of a health condition you already have.

Plans differ in monthly cost, deductibles, doctor and hospital networks, and covered medications. That is where we spend most of our time with you.

When you can enroll

You can enroll once a year during Open Enrollment. Outside that period you can enroll only if you qualify for a Special Enrollment Period, which follows certain life events:

• Losing health coverage — from a job, Medicaid or CHIP, or a family member's plan
• A change in your household — marriage, a birth or adoption, divorce, or a death
• A move to a new ZIP code or county, or to the United States from abroad
• Other qualifying changes, such as becoming a U.S. citizen

The window to enroll after a life event is short, so call us as soon as something changes. Current dates and deadlines are on HealthCare.gov.

At tax time

If advance payments of the premium tax credit were made for you, you must file a federal income tax return for that year — even if you would not otherwise have to file — and reconcile those payments on Form 8962, using the Form 1095-A the Marketplace sends you.

Report income and household changes to the Marketplace as soon as possible during the year. A higher income than you estimated can mean repaying part of the credit when you file.