Fact Sheet: The Affordable Care Act Marketplace Exchange

This document has been updated for the 2024–2025 enrollment period.

Premium Tax Credits

The Inflation Reduction Act of 2022 (IRA) passed Congress with a three-year extension of enhanced Affordable Care Act premium tax credits. As such, the IRA extends the enhanced credits provided by the American Rescue Plan Act, which significantly reduced premiums for Marketplace enrollees with low/middle incomes and capped premiums at 8.5% of income. The impact of the extension of the enhanced premiums tax credits is estimated to prevent 13 million people from experiencing an increase in premiums and 3 million people from becoming uninsured.

Due to these expanded tax credits, in 2024, most consumers qualified for $0 premiums or continued to see annual premium savings exceeding $800 during the last Open Enrollment Period. It is expected that consumers will see similar savings during this year’s Open Enrollment Period, as well.

Marketplace Open Enrollment and Special Enrollment Period

Marketplace Open Enrollment begins November 1 through January 15 for both HealthCare.gov and the 20 states that run their own marketplaces. Open Enrollment can last even longer in states that run their own State-based Marketplace. Consumers who enroll by midnight on December 15 can get full-year coverage that starts January 1. Consumers who select a plan between December 16 and the end of open enrollment on January 15 can have coverage that starts February 1, 2025.

Individuals who have lost Medicaid or CHIP coverage during the redetermination period can apply for Marketplace coverage right away! They may be able to get low-cost, quality health coverage through the Marketplace.

A Special Enrollment Period has been granted for Deferred Action for Childhood Arrivals (DACA) recipients. Starting November 1, corresponding with Open Enrollment, otherwise eligible DACA recipients will be able to enroll in a Marketplace plan and may be eligible for premium tax credits and cost-sharing reductions to help lower health insurance costs. DACA recipients who meet the eligibility criteria for coverage will qualify for a 60-day Special Enrollment Period to select and enroll in a health plan through the Marketplace. Eligible DACA recipients who want 2024 coverage should select a plan by November 30, 2024, to have coverage that begins on December 1, 2024.These changes will help make health care more affordable for thousands of DACA recipients in 2025, including many who are currently uninsured or underinsured. CMS has released a new toolkit to help share information with DACA recipients who will be able to enroll in health coverage through the Marketplace for the first time. These resources can be used on social media, in listservs, and in other modes of communication. The toolkit includes the following resources: Drop-In Article, Fact Sheet, Fillable Flyer, Frequently Asked Questions, Postcard, Social Media Messages, and Social Media Graphics. In addition, healthcare.gov/immigrants/coverage/ includes more information on health coverage for immigrants.

Other special enrollment periods for change of life events can be found at https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/.

Consumers may access the Marketplace and/or seek assistance by undertaking the following actions:

• Consumers can sign up for health insurance in the Marketplace at www.HealthCare.gov or https://www.cuidadodesalud.gov/es/.
• Consumers can call 1-800-318-2596 to fill out an application. Free help is available 24 hours/7 days a week, and assistance is available in over 200 languages.
• A consumer can determine if their estimated income may qualify for a premium tax credit by entering information at https://www.healthcare.gov/lower-costs/.
• Consumers can obtain local help from a Navigator or certified application counselor, or to be contacted by a Marketplace-registered agent or broker, by going to https://www.healthcare.gov/find-local-help/. This webpage allows a consumer to search the online directory and set up a time to talk in-person, over the phone, or by email. CMS previously announced awards of $100 million to Navigator organizations, which are vital to helping underserved communities, consumers, and small businesses find and enroll in health coverage through the Marketplace. CMS has also implemented a number of changes this year to protect consumers from unauthorized changes in their enrollments.
• If a state operates its own Marketplace, consumers in those states need to visit or call the state’s Marketplace to enroll in a Marketplace plan and/or obtain information about available plans, prices, how to obtain in-person or virtual help, and news on local enrollment events. For a list of states that operate their own Marketplace platform as well as those states’ enrollment deadlines and other information, please access https://www.cms.gov/files/document/state-exchange-oe-chart-py-2025.pdf

Benefits of Marketplace Coverage

The Marketplace may provide coverage under certain circumstances where an individual’s employer-sponsored coverage is cost prohibitive as defined by the ACA. The Marketplace can also assist with addressing coverage gaps, such as when an individual is disenrolled from Medicaid during Medicaid redetermination. In addition, the Marketplace can provide coverage to individuals that may not be covered under the employer insurance, such as individuals working for small employers or part-time individuals.

Individuals continue to have the option to compare plans that work best for them on the Marketplace, and 97 percent will be able to choose plans from among at least three insurance issuers. All Marketplace plans cover prescription drugs, doctor visits, urgent care, hospital visits, and more. Individuals continue to have access to both standardized plans and non-standardized plans so they can pick the right plan for their needs. Standardized plans include enhanced pre-deductible coverage for a range of key benefits at every metal level, while non-standardized plans may be better suited for individuals with more unique health care needs. New for 2025, individuals may also have access to non-standardized plans that target chronic and high-cost conditions by reducing cost sharing for services relevant to the treatment of these conditions.

Additionally, individuals will not only have access to greater plan choices for 2025 but also will benefit from an improved shopping experience, improved HealthCare.gov navigation, and enhancements to selecting a plan. CMS redesigned the HealthCare.gov homepage and Marketplace account section, for example, to make deadlines clearer, highlight important actions consumers must take to select their health coverage choices and improve usability on mobile devices.

For subsidy assistance, due to the subsidies within the IRA, for 2024, most consumers qualified for $0 premiums or continued to see annual premium savings exceeding $800 and it is expected that consumers will see similar savings during this year’s Open Enrollment Period, as well.

For families, the “Family Glitch” has long prevented families from obtaining the same subsidies within the Marketplace. However, that has changed. The Department of the Treasury announced a final rule that amended the regulations for premium tax credits meant to reduce the cost of coverage for plans on the Health Insurance Marketplace and expanded eligibility for ACA tax credits for people whose employer-sponsored insurance is unaffordable (roughly 10% of household income in 2024). As such, the final rule allows family members of workers to now qualify for premium tax credits if the family coverage exceeds the threshold. The final rule is predicted to result in nearly 1 million additional people gaining coverage or seeing insurance costs decrease.

• The Department of Treasury’s final rule can be accessed at https://public-inspection.federalregister.gov/2022-22184.pdf.
• The press release and statements on impact from Department of Health and Human Services can be accessed at https://www.hhs.gov/about/news/2022/10/11/statement-hhs-secretary-xavier-becerra-administration-action-resolve-family-glitch-lower-health-care-costs.html.
• For additional information on the “Family Glitch,” the White House Fact Sheet can be accessed at https://www.whitehouse.gov/briefing-room/statements-releases/2022/04/05/fact-sheet-biden-harris-administration-proposes-rule-to-fix-family-glitch-and-lower-health-care-costs/.

Additional Marketplace Resources

• A Marketplace fact sheet can be accessed at https://www.cms.gov/newsroom/fact-sheets/marketplace-2025-open-enrollment-fact-sheet and infographic.
• A breakdown of county-by-county insurer participation in the Marketplace can be accessed via a map at https://www.cms.gov/files/document/cms-cciio-draft-py-24-public-facing-map10262023v1.pdf
• Additional resources include:
  • The Plan Year 2025 Qualified Health Plan and Premiums in HealthCare.gov States – Report, Appendix Tables, and Methodology.
  • The Plan Year 2025 Health Insurance Marketplace® Public Use Files.
  • Information on Quality Ratings for Plan Year 2025.
  • The Plan Year 2025 Projected Health Insurance Exchange Coverage Map.
  • The Plan Year 2025 State-based Marketplace Open Enrollment Fact Sheet.
• The Kaiser Family Foundation (KFF) also released several resources that can be found at https://www.kff.org/understanding-health-insurance-marketplaces/ and includes:
  • The Health Insurance Marketplace Calculator updated with 2025 premium data, provides estimates of health insurance premiums and subsidies for people purchasing insurance through the Marketplace. The calculator allows users to enter age, income, zip code, and family size information to estimate their eligibility for subsidies and how much they may expect to spend on health insurance premiums or if they may be eligible for Medicaid.
  • The FAQ Database covers a wide range of topics related to obtaining or renewing Marketplace coverage. More than 200 of the FAQs in the collection are also available in Spanish.
  • Questions about Health Insurance Subsidies available for individuals purchasing their own coverage, including premium tax credits and cost-sharing subsidies. KFF has also updated select State Health Facts indicators with relevant data.