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  • I heard that plans have to cover preventive services without cost sharing. Does this include every preventive service and are there any limitations or exceptions?

    FAQs

    Most health plans, including Marketplace plans, are required to cover a wide range of preventive services and may not impose cost-sharing (such as deductibles, copayments, or co-insurance). The ACA requires private plans to cover services under four broad categories: Evidence-based screenings and counseling Routine immunizations Childhood preventive services Preventive services for women So long as the preventive service is performed by an in-network provider, is not billed separately from the office visit, and is the main…

  • What is a Catastrophic health plan?

    FAQs

    A “Catastrophic plan” is a qualified health plan offered on or off the Marketplace that covers the “essential health benefits.” While Catastrophic plans have lower premiums than other qualified health plans, they also have the highest level of cost sharing allowable for an ACA-compliant plan. For 2026, the annual deductible for covered services in a Catastrophic plan is $10,600 for an individual or $21,200 for a family. The plan does not have to cover more…

  • I’m covered under my parents’ plan, and I’m pregnant. Will my parents’ plan cover my prenatal care and delivery?

    FAQs

    Federal laws require most employer-sponsored plans and all ACA-compliant individual insurance plans, including those available through the Marketplaces, to cover maternity services, including pregnancy, childbirth, and newborn care. Cost sharing may apply to some maternity services. Most private plans also must cover prenatal visits and screenings, folic acid supplements, tobacco cessation counseling and interventions, and breastfeeding services without any cost-sharing because they are considered preventive services. Some health plans are not required to cover all…

  • I’m divorced and I pay alimony to my ex-spouse. Does that affect my income for determining eligibility for premium tax credits?

    FAQs

    Federal tax rules set out what is included in your household income. Eligibility for and the amount of premium tax credits are largely based on your household income. Check with a tax advisor, but in general, for divorce or separation agreements after December 31, 2018, alimony payments are no longer deductible from the income of the paying ex-spouse, and alimony is not included as income for the recipient ex-spouse. For pre-2019 divorces, the paying ex-spouse…

  • My income is low enough that I qualify for advanced premium tax credits (APTCs), but I have never filed a federal tax return before. Can I still receive APTCs?

    FAQs

    If this is your first time applying for premium tax credits, then yes. There is no requirement to have filed a tax return for any prior year to qualify for premium tax credits. However, because you have never filed a federal tax return, you will likely have to provide additional documentation (such as pay stubs or a work contract) to the Marketplace within 90 days to verify your projected household income for premium tax credits. …

  • What happens with the premium tax credits if we want different Marketplace plans for different family members?

    FAQs

    Assuming you are part of one application, the members of your household can enroll in separate plans in a health insurance Marketplace. For example, you may want separate plans because a grown child lives in another part of the state or because your spouse needs a plan with a different provider network than the one you chose. The premium tax credit will be allocated to the plans in which different family members enroll. However, if…

  • Should I claim a premium tax credit in advance, at the end of the year, or some of both?

    FAQs

    That’s up to you. You can have tax credits paid directly to your health plan each month to reduce your monthly premium right away, or, if you can afford to, you can pay the entire health plan premium yourself up front and collect the premium tax credit in a lump sum next year when you file your tax return. Alternatively, you can have some of the tax credit paid directly to your insurer in advance…

  • What are premium tax credits and how do they work?

    FAQs

    Premium tax credits reduce your premium for most Marketplace plans. The amount of the tax credit you may receive depends on your income and the cost of Marketplace health plans in your area. The Marketplace will determine the expected contribution you are required to pay toward the premium for a mid-range (Silver) benchmark plan. The expected contribution will increase on a sliding scale based on your 2026 income, with more financial assistance for enrollees with…