To enroll in health insurance in the Affordable Care Act (ACA) Marketplace, you must meet a few basic qualifications. If you don’t already have health insurance through a job or other source, such as Medicare or Medicaid, you may be able to get coverage through the ACA Marketplace.
The ACA Marketplace provides insurance for those without other coverage.
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Who Is Eligible for ACA Marketplace Health Insurance?
In order to enroll in a health insurance plan in the ACA marketplace, you must:
- Live in the United States
- Be a U.S. citizen or national, or be lawfully present in the United States
- Not be in prison or jail
Living in the U.S. means residing in one of the 50 U.S. states or Washington, DC. In order to apply for ACA Marketplace coverage, you must provide an address. People without an address or those experiencing homelessness can provide the address of a family member, friend, or shelter in the state they are seeking health care services. A P.O. Box also counts for an address.
If you’re what the Internal Revenue Service (IRS) considers a U.S. resident for tax reasons, you qualify for Marketplace coverage. But keep in mind that ACA Marketplace plans only cover health care services provided within the U.S.
For more information about immigration statuses that qualify for the ACA Marketplace, check the HealthCare.gov website.
There is no income limit to qualify for the ACA Marketplace. This means there is no minimum or maximum income required to be eligible for Marketplace coverage.
Coverage for Young Adults
Young people are eligible to stay on their parent’s health plan until they are 26 years old. After that, they need to get their own coverage. Young people who don’t have job-based insurance can apply for coverage through the ACA Marketplace.
Options for applying for ACA Marketplace health insurance plans depend on whether their parent had health insurance through their job or the Marketplace.
Pre-Existing Conditions
The ACA requires all health insurance plans, inside or outside the ACA Marketplace, to provide coverage for people with pre-existing conditions. This means that having a pre-existing condition doesn’t prevent you from qualifying for health insurance through the ACA Marketplace. Furthermore, health insurance plans can’t charge you more because of a pre-existing condition.
Marketplace Plans and Other Federal Health Plans
The ACA Marketplace provides health care coverage options to people who don’t already have health insurance. Federally sponsored health plans, such as Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP), are their own forms of health insurance and are not part of the ACA Marketplace.
If you have Medicare, you don’t need to change anything. You can’t be on Medicare and enroll in the Marketplace. You may be able to choose private health insurance through the Marketplace instead of Medicare in a few select situations.
Medicaid and CHIP are also separate from the ACA Marketplace. If you lose or are denied Medicaid or CHIP coverage, you can apply for ACA Marketplace coverage. In this case, you may be eligible for savings with Marketplace health plans.
What You Need to Enroll
When you enroll in the ACA Marketplace, you need to provide information about you and anyone else you are applying for health care coverage for.
Here is a general list of the type of information you will need to provide:
- Basic personal information, like your name and birth date
- Home address or mailing address
- Information about everyone in your household, including those applying for coverage and those not applying for coverage
- The social security number for each person in the household
- Immigration documents for those applying for coverage who are a lawfully present immigrant, if applicable
- Information about how you file your taxes
- Information about your current health care coverage
- Estimated household income, including employer and income information for everyone in the household
- A Health Reimbursement Arrangement (HRA) notice, if applicable
- Information about a professional helping you with your application, such as a health insurance navigator, if applicable
When You Can Enroll
The Open Enrollment period for the ACA Marketplace happens every year from November 1 to January 15. If you enroll by December 15, your health insurance starts January 1. If you enroll between December 16 and January 15, your plan starts February 1. You must pay your first premium for your health insurance to start.
You may be eligible to apply for ACA Marketplace outside the open enrollment period if you have certain life events. This is called a Special Enrollment Period. Examples of qualifying life events include:
- Loss of your current health insurance, such as job-based insurance, Medicaid, or CHIP
- A change in where you live
- Changes to your household, such as getting married or divorced, or having a baby
Key Takeaways
- The ACA Marketplace offers health insurance for people without coverage from other sources.
- To qualify, you must live in the U.S., be a citizen or lawfully present, and not be incarcerated.
- All ACA plans must cover essential services, including care for pre-existing conditions.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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