Marketplace plans can be purchased in the following circumstances:

1. During the Open Enrollment Period

2. During a Special Enrollment Period

3. If you are eligible for Medicaid or CHIP

4. If you applied for Medicaid or CHIP during open enrollment and find out you're ineligible after open enrollment ends

5. If you are Native American

6. NY, MN, and MA residents with "fairly low income"

The Open Enrollment Period is the yearly period in the fall when you can enroll in a health insurance plan via the Insurance Marketplace on healthcare.gov for the next calendar year. Open Enrollment occurs at the end of the year November 1 through December 15 (sometimes ending later, as this end date varies by state). Once you enroll, your new insurance coverage will begin on January 1 of the New Year.

With a Special Enrollment Period, you must have a qualified life event for an individual or family to purchase health insurance outside of the annual ACA Open Enrollment Period. Examples of qualifying life events are loss of other insurance coverage, the birth or adoption of a child, marriage, divorce, moving, or certain other life changes. If eligible, you may qualify for help paying for coverage, even if you weren’t eligible in the past.

There is a 60-day window through the marketplace that triggers a Special Enrollment Period when an individual experiences a qualifying life event. For Medicare coverage, most qualifying events trigger 2-month special enrollment periods, but there are exceptions.

*Although loss of existing minimum essential coverage is a qualifying event that triggers a special open enrollment period for ACA-compliant individual market plans, Short-Term policies are not considered minimum essential coverage, so the loss of Short-Term coverage is not a qualifying event.

Through Medicaid or the Children's Health Insurance Program (CHIP), You can apply any time and can enroll immediately if you're eligible. If you are denied coverage and deemed ineligible for Medicaid or CHIP after open enrollment ends, you will be able to apply for a new insurance plan through the Marketplace.

To be eligible as a Native American for open enrollment, you must be a member of a recognized Indian tribe, band, or nation, according to the Indian Healthcare Improvement Act.

New York (the Essential Plan) and Minnesota (MinnesotaCare) both offer year-round enrollment and are available to residents with income up to 200% of the poverty level.

Massachusetts (ConnectorCare) is available to residents with income up to 300% of the poverty level.

You can report changes to the Marketplace 3 ways: online, by phone, or in person — not by mail. It's important to report any changes as soon as possible. These changes may affect your coverage and savings.

You can upload the documents online, which is the fastest and easiest way to get them processed. Or you can mail copies instead.

When you have Marketplace insurance, you'll pay your premiums directly to the insurance company — not to the Health Insurance Marketplace®. Your coverage won't start until you pay your first premium.

If you are qualified for a health plan through the Affordable Care Act (through open enrollment or a qualifying life event), you can start by going to, you can apply for health coverage in several ways:

• Online at healthcare.gov

• By phone

• With the help of someone in your community

• Through an agent/broker

• Through certified enrollment partner websites

• With a paper application

• The most common, and easiest, way to review and choose a health plan is to go to healthcare.gov. This will allow you to visually view health plans side-by-side to compare coverage.

Yes, though there are certain circumstances to qualify for insurance through the Marketplace.

Click here to learn more.

You must:

• Live in the United States

• Be a US citizen or national, or be lawfully present in the United States

• Not be incarcerated, though you can enroll once you are no longer incarcerated

• Not have an active Medicare plan

• You can have both a Marketplace plan and Medicaid, but you're not eligible to receive advance payments of the premium tax credit or other cost savings to help pay for your share of the Marketplace plan premium if you are enrolled in Medicaid.

With ACA plans through the insurance marketplace, you can’t be denied coverage or denied the minimum 10 essential health benefits these plans must cover. ACA plans can offer additional benefits, but these 10 must be included in any ACA-compliant plan.

To apply for one of the ACA medical plans, you must enroll during the Open Enrollment Period or Special Enrollment Period through the Insurance Marketplace. For Medical plans purchased off the marketplace, directly through an insurance payor, Open Enrollment rules still apply, and the plans must be ACA-compliant.

Short-Term Medical plans are generally less expensive but only cover conditions that first develop once the person is insured by the plan, are not ACA-compliant.

1. Outpatient care

2. Prescription drugs

3. Emergency services

4. Mental-health and addiction treatment

5. Hospitalization

6. Rehabilitative services and devices

7. Preventive, wellness, and chronic disease treatment

8. Laboratory services

9. Pediatric care

10. Maternity and newborn care

Some signs that a health policy is NOT ACA-compliant include:

• The application asks questions about your health status or health history

• The policy doesn’t cover essential benefits, such as maternity care or prescription drugs

• The policy has annual or lifetime dollar caps on covered benefits

• The policy is offered for sale outside of Open Enrollment to people regardless of whether they’re eligible for an SEP, for example, because they recently lost other coverage

• Plans that are not ACA-compliant, including short-term health insurance, may have lower premiums because they can exclude people with pre-existing conditions and offer more limited benefits.

Project HEAL offers annual 1:1 support via phone or Zoom call to help assist in choosing a plan that will meet individuals and treatment. An Open Enrollment Webinar is also located on our website here.

Out2Enroll is a "a national initiative launched in September 2013 to connect our communities — LGBTQ+ people and our families, friends, and allies—with the new health insurance coverage options available under the Affordable Care Act." Out2Enroll also lists Transgender Health Resource Guides, by state here.