Individual & Family Health Insurance
The Health Insurance Marketplace Open Enrollment Period is November 1–January 15. During this time you can sign up, renew, or change a health plan for the next year. To have coverage start on January 1, you must enroll by December 15. For coverage to begin on February 1, you must enroll by January 15. You may enroll or make changes outside of the Open Enrollment Period if you qualify for a Special Election Period due to a qualifying life event. Health Insurance plans fall within four categories; Platinum, Gold, Silver, or Bronze. You do not have to get health insurance through the marketplace or your employer, but you may be required to have health coverage that meets the Affordable Care Act (ACA) standards. You may compare and enroll in a health insurance plan using our Shop Health Insurance link below.
Medicare Beneficiaries cannot have insurance through the Marketplace, and it is illegal for an insurance agent to sell you a Marketplace plan. If you are eligible for Medicare you may visit our Medicare Page and choose a Medicare Plan that fits you.
Contact The Holden Agency for a complete explanation of your Health Insurance options at (855) 722-1582.
Platinum Plans
Your Plan Pays 90% of Costs
These plans are best for those individuals and families who require ongoing medical care and want more predictable out-of-pocket costs.
- Highest monthly premium
- Lowest deductible
- Coverage for majority of healthcare costs
- You pay up to 10% of covered medical expenses
Gold Plans
Your Plan Pays 80% of Costs
Gold plans are ideal for individuals and families needing frequent medical services and want their insurer to share more in the cost for care.
- Higher Monthly Premium
- Lower deductible
- Lower out-of-pocket costs for frequent healthcare needs
- You pay up to 20% of covered medical expenses
Silver Plans
Your Plan Pays 70% of Costs
Popular choice for many individuals and families, because they provide a higher percentage of cost-sharing with the insurer and provide the same essential health coverage as Bronze plans.
- Moderate monthly premium
- Lower deductible
- Only tier that offer access to cost-sharing reductions
- Cost-sharing reductions based on family size and household income
- You pay up to 30% of covered medical expenses
Bronze Plans
Your Plan Pays 60% of Costs
These plans are ideal for individuals and families who are generally healthy and don’t anticipate needing many medical services throughout the year.
- Lowest monthly premium
- Highest deductible
- Highest out-of-pocket costs
- Covers Essential Health Benefits
- You pay up to 40% of covered medical expenses
Essential Health Benefits
Essential Health Benefits are a set of 10 categories of services that most health plans must cover under the Affordable Care Act. All Health Insurance Marketplace plans regardless of metal level, cover the same 10 essential health benefits.
These categories include:
- Ambulatory Services
- Emergency Services
- Hospitalization
- Maternity & Newborn Care
- Mental Health & Substance Use Services
- Prescription Drugs
- Rehabilitative Services
- Laboratory Services
- Preventive and Wellness services
- Pediatric Services
Cost Sharing Reductions
Cost-sharing reductions (CSRs) are discounts that lower the out-of-pocket costs like deductibles, copayments, and coinsurance for certain individuals who enroll in a Silver health plan through the Health Insurance Marketplace.
To qualify, individuals must have a household income between 100% and 250% of the federal poverty level and be eligible for a premium tax credit. The amount of savings depends on your income level, with lower incomes receiving more significant reductions.
Advance Premium Tax Credit
The Advance Premium Tax Credit (APTC) is a refundable tax credit that you can take in advance to lower your monthly health insurance premium when you enroll in a plan through the Health Insurance Marketplace. The government pays your estimated credit directly to your insurer each month, and you pay the difference. When you apply for health coverage on HealthCare.gov, the Marketplace estimates your expected income for the year and determines if you qualify for the premium tax credit.
- If you received too much APTC the difference is added to your tax liability, which means a smaller refund or a larger balance due when you file your taxes.
- If you received too little APTC you can claim the difference as a refundable tax credit, which increases your refund or lowers your tax bill.