You can get private health insurance through the federal marketplace at HealthCare.gov, a state-run exchange, or directly from an insurance company or broker. For plan year 2026, open enrollment runs from November 1 through January 15, and outside that window you need a qualifying life event, like losing job-based coverage, getting married, or having a baby, to enroll. What you pay depends on where you buy, which plan tier you pick, your household income, and whether you qualify for premium tax credits that lower your monthly bill.
Where You Can Buy a Plan
Three paths lead to private coverage, and the one you choose decides whether financial help is on the table.
The Health Insurance Marketplace is HealthCare.gov or your state’s own exchange if it runs one. Every plan sold there is ACA-compliant, meaning it covers essential health benefits and cannot deny you or charge more because of a pre-existing condition.1HealthCare.gov. Coverage for Pre-existing Conditions Marketplace plans are also the only ones eligible for premium tax credits and cost-sharing reductions.
Off-marketplace plans are ACA-compliant policies you buy directly from an insurance company or through a broker. They follow the same coverage rules as marketplace plans, but you cannot apply subsidies to them. If your income disqualifies you from premium tax credits anyway, going off-marketplace can widen your options.
Non-ACA plans, including short-term health insurance and health care sharing ministries, sit outside the rules that govern the marketplace. They tend to be cheaper up front and much thinner on coverage. More on those below.
Brokers and agents can help you compare plans across multiple carriers. Their commissions come from the insurance companies, so their help costs you nothing directly. If you would rather work on your own, HealthCare.gov lets you compare plans side by side and apply for subsidies in the same session.
When You Can Enroll
ACA-compliant plans run on an annual open enrollment cycle. For 2026, HealthCare.gov’s window is November 1 through January 15.2HealthCare.gov. When Can You Get Health Insurance Enroll by December 15 and coverage starts January 1. Enroll between December 16 and January 15 and coverage starts February 1. Some state exchanges use different deadlines, so check your state’s marketplace if you don’t use HealthCare.gov.
Miss the window and you need a qualifying life event to trigger a special enrollment period. The common ones are losing employer or other qualifying coverage, getting married, having or adopting a baby, or moving to a new area with different plan options. Special enrollment periods generally last 60 days from the date of the event.2HealthCare.gov. When Can You Get Health Insurance
If You Just Lost Job-Based Coverage
You’ll usually have two choices: continue your former employer’s plan through COBRA, or move to a marketplace plan. COBRA lets you keep the group plan for 18 months in most situations, or up to 36 months for events like divorce or a spouse’s death, but you pay the full premium plus a 2% administrative fee.3U.S. Department of Labor. COBRA Continuation Coverage You have 60 days to elect COBRA after your employer benefits end.
Here’s the trap. Losing job-based coverage also opens a 60-day special enrollment period for the marketplace. If you elect COBRA and later decide to drop it voluntarily, you do not get another special enrollment period. You’d have to wait for open enrollment.4HealthCare.gov. COBRA Coverage When You’re Unemployed The exception is if COBRA runs out on its own or your former employer stops contributing. Before committing to COBRA, price a marketplace plan with any subsidies you may qualify for. The math often favors the marketplace.
What It Will Cost
Your total cost is more than the monthly premium. Four numbers matter together: the premium, the deductible, cost-sharing (copays or coinsurance) after you meet the deductible, and the out-of-pocket maximum that caps your annual exposure.
Under ACA rules, insurers can vary premiums based only on your age, location, tobacco use, plan tier, and whether you cover dependents.5HealthCare.gov. How Health Insurance Marketplace Plans Set Your Premiums Older enrollees can be charged up to three times more than younger ones, and tobacco users can face a surcharge of up to 50%.6Centers for Medicare & Medicaid Services. Market Rating Reforms For 2026, the average marketplace premium after tax credits is projected at about $50 per month for the lowest-cost plan among eligible enrollees.7Centers for Medicare & Medicaid Services. Plan Year 2026 Marketplace Plans and Prices Fact Sheet Without subsidies, prices vary widely by region and age.
The out-of-pocket maximum for any ACA-compliant plan in 2026 is $10,600 for individual coverage and $21,200 for family coverage.8HealthCare.gov. Out-of-Pocket Maximum/Limit Once you hit that ceiling, the plan covers 100% of eligible services for the rest of the year.
Premium Tax Credits and Cost-Sharing Reductions
Marketplace plans are the only way to get financial help. For 2026, premium tax credits are available to households with income between 100% and 400% of the federal poverty level.9Internal Revenue Service. Eligibility for the Premium Tax Credit This is a change from recent years. Between 2021 and 2025, enhanced credits extended eligibility above 400% of the poverty line under temporary expansions that expired at the end of 2025.
You can take the credit in advance each month, which lowers your premium bill, or claim it at tax time. If your income shifts during the year, update your marketplace application. Receiving more advance credits than you were entitled to means you’ll owe the excess back on your return.
Silver-tier marketplace plans also offer cost-sharing reductions for households between 100% and 250% of the federal poverty level. These reductions cut your deductibles, copays, and out-of-pocket maximum. They apply only to Silver plans purchased on the exchange. An off-marketplace Silver plan does not carry them.
Choosing How You Access Care: Plan Types
The letters after each plan name tell you how you get to doctors, whether you need referrals, and what happens if you go out of network.
HMO
A Health Maintenance Organization requires a primary care physician who coordinates your care and issues referrals to specialists. You generally must stay in network, and out-of-network care is not covered except in emergencies.10Medicare.gov. Health Maintenance Organizations (HMOs) HMO premiums and out-of-pocket costs tend to be the lowest of any plan type. Good fit if your doctors are in network and referrals don’t bother you.
PPO
A Preferred Provider Organization lets you see any doctor or specialist without a referral. In-network care costs less, and out-of-network care is still partially covered. Premiums are higher. Worth it if you travel often, want direct specialist access, or won’t give up out-of-network providers.
EPO
An Exclusive Provider Organization skips referrals like a PPO but locks you into the network like an HMO, with no out-of-network coverage outside emergencies. Premiums usually land between HMO and PPO. Fine in an area with a strong network, risky if you need care while traveling.
POS
A Point of Service plan combines the two: a primary care physician and referrals for specialists, plus some out-of-network coverage at higher cost-sharing. Less common, but a middle ground worth checking.
Metal Tiers
Marketplace plans sort into metal tiers by how you and the insurer split costs. The tier decides the balance between the monthly premium and what you pay when you actually use care.
- Bronze: plan pays about 60%, you pay 40%. Lowest premiums, highest costs at the point of care.11HealthCare.gov. Health Plan Categories: Bronze, Silver, Gold, and Platinum
- Silver: plan pays about 70%, you pay 30%. The only tier eligible for cost-sharing reductions if your income qualifies.
- Gold: plan pays about 80%, you pay 20%. Higher premiums, more predictable costs for frequent care.
- Platinum: plan pays about 90%, you pay 10%. Highest premiums, lowest cost-sharing.
Catastrophic plans are a fifth option available only to people under 30 or those with a hardship or affordability exemption.12HealthCare.gov. Catastrophic Health Plans They cover three primary care visits and free preventive services before the deductible, then you pay full cost until a high deductible is met. They’re designed as a worst-case safety net, not everyday coverage.
Starting in 2026, both Bronze and Catastrophic marketplace plans are treated as HSA-compatible high-deductible health plans even if they don’t meet the traditional HDHP definition, so enrollees in these plans can contribute to a Health Savings Account.13Internal Revenue Service. Treasury, IRS Provide Guidance on New Tax Benefits for Health Savings Account Participants Under the One, Big, Beautiful Bill
What You’ll Need to Apply
Every application asks for basic personal information: name, date of birth, Social Security number, and home address. Marketplace applications also ask for household size and estimated annual income to calculate subsidy eligibility.
If you’re applying for financial help, expect to document your income. Pay stubs, tax returns, and bank statements are common. Self-employed applicants often provide profit-and-loss statements or a prior-year Schedule C. If you’re enrolling during a special enrollment period, be ready to prove the qualifying event with a termination letter, marriage certificate, birth certificate, or similar document.
ACA-compliant plans cannot require your medical history as part of the application.14eCFR. 45 CFR 147.108 – Prohibition of Preexisting Condition Exclusions Short-term plans, on the other hand, may include medical underwriting where you disclose diagnoses, medications, and hospitalizations, and the insurer uses that to decide whether to offer coverage at all.
Marketplace applications usually deliver same-day eligibility results and plan options. Off-marketplace applications submitted straight to insurers can take longer. Check your email for document requests and respond quickly to keep your coverage start date on track.
A Warning on Short-Term Plans
Short-term health insurance is not ACA-compliant. These plans can deny coverage for pre-existing conditions, exclude essential health benefits, impose annual or lifetime dollar limits, and cancel your policy based on your claims history.15Centers for Medicare & Medicaid Services. Short-Term, Limited-Duration Insurance and Independent, Noncoordinated Excepted Benefits Coverage Under current federal rules, short-term plans are limited to an initial term of three months and a maximum total duration of four months including renewals.
They can work as gap coverage between jobs. They’re a poor substitute for real insurance. If you take any prescription medication or have any ongoing condition, a short-term plan may refuse to cover it. You also cannot use premium tax credits, because these plans aren’t sold on the marketplace.
After You Enroll
Missed Premium Payments
If you receive advance premium tax credits, federal law gives you a 90-day grace period before your insurer can cancel coverage.16eCFR. 45 CFR 156.270 – Termination of Coverage or Enrollment for Qualified Health Plans During the first 30 days, the insurer keeps paying claims normally. In months two and three, it may hold claims and warn providers that payment could be denied. Pay the overdue premium before day 90 and coverage continues. Miss the deadline and the insurer can terminate coverage retroactively to day 31, leaving months two and three unpaid. Without tax credits, most insurers offer a shorter grace period, often 30 days, though this varies by state.
Surprise Bills
The No Surprises Act protects you from unexpected bills when you get emergency care from an out-of-network provider or are treated by an out-of-network doctor at an in-network facility without consenting to it. Emergency services cannot result in balance bills regardless of whether the provider is in network, and you owe only your normal in-network cost-sharing.17U.S. Department of Labor. Avoid Surprise Healthcare Expenses: How the No Surprises Act Can Help The law also covers ancillary services like anesthesiology, radiology, and pathology when an out-of-network professional provides them at an in-network hospital or surgical center, and it extends to air ambulance services if your plan covers them.
Coverage Denials
If your insurer denies a claim, you can file an internal appeal within 180 days of the denial notice.18HealthCare.gov. Internal Appeals The insurer must respond within 30 days for pre-service denials, 60 days for post-service denials, and 72 hours in urgent situations.19Centers for Medicare & Medicaid Services. Internal Claims and Appeals and the External Review Process If the internal appeal fails, you can request an external review by an independent third party. You have four months from the final internal denial to file. Standard external reviews are decided within 45 days, expedited ones within 72 hours.20HealthCare.gov. External Review The cost is either nothing or a maximum of $25. Most people give up too early. File the appeal.
Renewal
Plans renew annually, and premiums, deductibles, and provider networks can change substantially year to year. Read the renewal notice rather than auto-renewing. If a doctor you’re actively seeing leaves your network mid-year, federal law requires the insurer to notify you, and you can continue treatment with that provider under in-network terms for up to 90 days.21Centers for Medicare & Medicaid Services. The No Surprises Act’s Continuity of Care, Provider Directory, and Public Disclosure Requirements Wanting a cheaper plan or a different network is not, on its own, a qualifying event, so marketplace enrollees who want to switch mid-year have to wait for open enrollment unless a life event opens the door.