What Is the Health Insurance Marketplace?

Marketplace plans come in four main “metal” levels: Bronze, Silver, Gold and Platinum. These categories show how you and the plan split costs, not how good the care is. 

• Bronze plans usually have the lowest monthly premiums but the highest costs when you get care, which can work if you rarely see a doctor and could handle a bigger bill once in a while. 
  
• Silver plans sit in the middle for both premiums and out-of-pocket costs. They’re also the only tier that can unlock extra savings on deductibles and copays for people who qualify. 
  
• Gold and Platinum plans have higher premiums but much lower costs when you use care, which can help if you expect regular visits, ongoing treatment or expensive medications.

Marketplace plans come in different network styles, including HMO, PPO, EPO and POS. 

• HMO (Health Maintenance Organization) plans ask you to pick a primary care doctor and stay in the network for most care. They often cost less each month but are less flexible if you like seeing out-of-network doctors.   
• PPO (Preferred Provider Organization) plans usually let you see out-of-network providers without a referral, but you’ll pay more to do it.   
• EPO (Exclusive Provider Organization) and POS (Point of Service) plans fall in between, combining network rules and referrals in different ways. Check whether your current doctors and preferred hospital are in the network before you enroll.

The premium tax credit is a refundable tax credit that helps eligible people pay their Marketplace premiums. It’s based on your household income and family size compared with the federal poverty level (FPL). In most years, people with incomes between about 100% and 400% of FPL qualify, and recent changes have allowed some families above 400% FPL to get help too. 

For 2026, 100% FPL is:   

• $15,650 for a household of one   
• $21,150 for a household of two   
• $26,650 for a household of three   
• $32,150 for a household of four

Using the 400% FPL guideline for premium tax credit eligibility, a single person may qualify up to roughly $62,600 in annual income. 

When you fill out your Marketplace application, the system estimates your tax credit and lets you decide how much to apply each month versus how much to keep for tax time. If your income is below about 138% FPL (for example, about $21,597 for a single adult in 2026) and your state has expanded Medicaid, you can qualify for Medicaid instead of a Marketplace plan.

If your income is near the lower or middle part of the FPL range, you may qualify for cost-sharing reductions, often called “extra savings.” These discounts lower what you pay for deductibles, copays and coinsurance and can reduce your yearly out-of-pocket maximum. 

There’s one important rule: you only get these extra savings if you enroll in a Silver plan. You can use the premium tax credit with any metal level, but cost-sharing reductions are tied to Silver plans only. If your budget is tight and you expect to use care in 2026, it’s worth checking what a Silver plan with extra savings looks like next to a cheaper Bronze plan with higher out-of-pocket costs. 

A low monthly premium looks appealing, but your total cost includes: 

• The premium you pay every month, even if you don’t see a doctor.
• The deductible you pay before the plan starts sharing costs.
• Copays and coinsurance when you get care.
• Your yearly out-of-pocket limit, the most you’ll pay for covered services in a year. 

A plan with a higher premium but lower deductible works well if you expect more care in 2026, like managing a chronic condition, planning a pregnancy or taking brand-name prescriptions. If you’re mostly using preventive visits and are comfortable with more financial risk if something big happens, a lower-premium, higher-deductible plan might still be the better match.