Enrollment & Eligibility
Learn who qualifies for Marketplace coverage, how financial savings work, and how to apply or enroll in a plan. This section covers income rules, household questions, deadlines, and special enrollment situations.
By Sam and 2 others3 authors23 articles
Who can buy coverage through the Marketplace?Explains who can buy Marketplace insurance, including the difference between U.S. citizenship and residency requirements, and outlines related eligibility rules for Medicaid, CHIP, employer plans, and Medicare.
Am I eligible for a Marketplace plan if my employer offers insurance?Explains how employer coverage affects Marketplace eligibility, including the 2026 affordability limit and family glitch fix.
Do I qualify for Marketplace insurance if I'm not a citizen or do not have a legal status?Explains Marketplace eligibility for non-citizens, including which immigration statuses qualify for coverage and what options are available for individuals without lawful status.
Are DACA individuals eligible for Medicaid, CHIP or the Marketplace ?Information for individuals with DACA status on current eligibility for health coverage and where to find affordable or free care through community clinics, state programs, and verified national resources.
Who is considered part of my household?Explains how to determine who counts in your Marketplace or Medicaid/CHIP household, including tax-filing rules, special cases like shared custody, college students, pregnancy, and how household size affects eligibility and…
Who should I include in my application?When applying, it's important to include everyone in your "tax household" on your application. Information about your entire tax household is needed to determine your eligibility.
What income should I include on my application for financial help?When applying for financial assistance, you'll need to provide your estimated Modified Adjusted Gross Income (MAGI) for the application year. This includes your MAGI, your spouse's, and any dependents who…
How do I estimate my household income?Guidance on what income to include when reporting your household’s Modified Adjusted Gross Income (MAGI) for Marketplace coverage, including which sources count, which don’t, and how income accuracy affects your…
Can I get subsidies if I’m married filing separately, or head of household?Guidance on how your tax-filing status affects eligibility for Marketplace premium tax credits, including details for married couples filing separately, head-of-household filers, and exceptions for domestic abuse or spousal abandonment.
Do I still qualify for savings on Marketplace coverage if I’m offered an Individual Coverage HRA (ICHRA)?Learn how an employer’s Individual Coverage Health Reimbursement Arrangement (ICHRA) may impact your Marketplace savings, when it’s considered affordable, and how to check your eligibility for premium tax credits.
I got denied Medicaid and do not qualify for a subsidy. What are my options?Overview of coverage and cost-saving options for individuals who don’t qualify for Medicaid or Marketplace subsidies, including state programs, community resources, and enrollment timelines.
My kids are eligible for CHIP. Can I enroll them in our marketplace health plan and get premium tax credits for them instead?Children who qualify for the Children's Health Insurance Program (CHIP) are not eligible for premium tax credits on a Marketplace health plan.
Do you offer standalone dental plans?Find out when you can buy a Marketplace dental plan, what’s included, and how standalone dental coverage works.
Can I still get health insurance if I have a pre-existing condition?Guidance on pre-existing condition protections under the Affordable Care Act (ACA), including coverage rules, examples of qualifying conditions, and details on what Marketplace plans must cover from the start of…
Does the marketplace cover infertility?The ACA requires individual and small-group health plans to cover 10 essential health benefits (EHB), but assisted reproductive technology / infertility is not categorized as an EHB unless a state…
When is Open Enrollment and can I enroll right now?Overview of Marketplace Open Enrollment dates for 2026 coverage, including federal and state-based marketplace timelines, qualifying life events for Special Enrollment Periods, and key deadlines for effective coverage start dates.
What are Qualifying Life Events?
I missed my employer’s Open Enrollment to sign up for health coverage. Can I get Marketplace coverage?No, missing your employer’s Open Enrollment window by itself does not qualify you for a Special Enrollment Period. But you may still have options through the Marketplace or other programs.
What happens if I get a QSEHRA letter from my employer?Learn what to do if your employer offers a QSEHRA. Find out how to enter your QSEHRA information during your Marketplace application, adjust your premium tax credit (APTC), and understand…
What happens if I accept an Individual Coverage HRA (ICHRA) offer?Learn how an ICHRA works, including how employer reimbursements apply to Marketplace plans, what happens if you accept or decline the offer, and how affordability rules affect your eligibility for…
How do I get a quote ?
How do I quote, apply and enroll on HealthSherpa?Step-by-step overview of how to quote, apply, and enroll in Marketplace coverage through HealthSherpa, including how to compare plans, submit documents, make payments, and complete enrollment.
How to complete your health plan enrollment after receiving a link from your agentThis article shows you how to complete your insurance plan enrollment when your agent sends you a link from HealthSherpa.