All health plans offered through the Marketplace must meet the requirements of “qualified health plans.

All qualified health plans offered in the Marketplace cover essential health benefits (EHB).

Although all Marketplace health plans are required to cover the ten categories of essential health benefits, insurers in many states have flexibility to modify coverage for some of the specific services within each category, subject to approval by their Marketplace.

Catastrophic plans have the highest cost sharing and lowest premiums. In 2025, Catastrophic plans will have an annual deductible of $9,200 ($18,400 for family plans).

Each plan sold in the Marketplace must provide a link on the Marketplace web site to its health provider directory so consumers can find out if their health providers are included. The provider network information from insurance companies must also tell you whether a provider is accepting new patients.

Plans are generally not required to cover care received from an out-of-network (OON) provider. When they do, it is often with much higher cost-sharing than for in-network services.

If your state uses HealthCare.gov (federally-facilitated Marketplace), a prescription look-up tool is available on HealthCare.gov that will tell you whether your health plan covers a prescription drug on its “formulary” (a list of covered drugs) and other information such as the cost sharing structure. A similar feature may be available if your state operates its own Marketplace website.

It depends on your age. Routine dental coverage for children ages 18 and under is an essential health benefit. This means it must be available to any children you have, either as a covered benefit under your health plan or as a free-standing dental plan.

Not if you're buying a Marketplace plan. These plans are not allowed to charge you more based on your health status or pre-existing condition. However, some plans, such as short-term policies, that are sold off the Marketplace might turn you down or charge you more based on your health status or pre-existing condition.

Yes, in most states you can, within limits. Federal rules allow insurers to charge older adults (e.g., in their sixties) up to three times the premium they would charge younger adults (e.g., in their early twenties), although states can establish lower limits or a complete prohibition on “age rating.