Health Insurance Marketplace: How Health Insurance Works in the USA

Planning a move to the United States requires attention to aspects that go far beyond visas and documentation. Health is one of the most important pillars of this transition, and understanding how health insurance works in the country is essential to avoid financial surprises and ensure proper care from day one. The American system operates very differently from the Brazilian one, and lack of knowledge can be costly-literally.

The Health Insurance Marketplace, a platform created by the federal government through the Affordable Care Act (ACA), popularly known as Obamacare, is the main starting point for those who need to purchase an individual health plan in the United States. In this guide, you will understand how the Marketplace works, who can enroll, what types of plans are available, and how to take advantage of government subsidies to reduce costs.

What Is the Marketplace?

The Health Insurance Marketplace is an online platform managed by the federal government-accessible at HealthCare.gov-that brings together private insurance plans in a single comparison environment. The ACA was signed in 2010, and the Marketplace began operating in October 2013, with the goal of making health insurance more accessible and transparent.

Among its main achievements are the establishment of minimum mandatory coverage standards for all plans and the prohibition of coverage denial due to pre-existing conditions. In addition, the law guarantees preventive services at no extra cost and offers government subsidies to reduce the value of monthly premiums.

Some states operate their own marketplaces-such as California, New York, and Massachusetts-but most use the federal HealthCare.gov platform. The structure is the same: compare plans, check subsidies, and purchase coverage in one place.

Who Can Enroll?

Eligibility to purchase a plan through the Marketplace is broad, but requires meeting specific criteria. The applicant must be a U.S. citizen, U.S. national, or be legally present in the U.S.-this includes Green Card holders, work visa holders, students with valid visas, and refugees.

Other requirements include not currently being incarcerated and not having Medicare coverage. Legal immigration status is a fundamental requirement for enrollment and access to subsidies. Undocumented immigrants are not eligible to enroll in the Marketplace or receive financial assistance, although they may purchase plans directly from insurers outside the platform.

Subsidies and Tax Credits

One of the biggest attractions of the Marketplace is the government subsidies, which can significantly reduce the monthly cost of insurance. The two main mechanisms are the Advanced Premium Tax Credits (APTC) and Cost-Sharing Reductions (CSR).

APTCs directly reduce the monthly premium of the plan. The calculation is based on household income relative to the Federal Poverty Level (FPL) and family size. The lower the income, the higher the subsidy. CSRs are available exclusively to those who choose Silver category plans and have income between 100% and 250% of the FPL, reducing deductibles, copayments, and coinsurance.

It is important to note that the expanded tax credits, approved during the pandemic and extended until the end of 2025, have expired. In 2026, subsidies returned to the original ACA formula, resulting in higher premiums for many families. Check your updated eligibility directly at HealthCare.gov.

Types of Plans Available

Marketplace plans are classified into four metal categories, which indicate the average proportion of medical costs covered by the insurer:

• Bronze: covers about 60% of costs. Lower monthly premiums, but higher deductibles and copayments. Suitable for healthy people who use few medical services.
• Silver: covers about 70% of costs. Balance between premium and out-of-pocket expenses. The only level eligible for CSRs, which can make it the best value for low-income families.
• Gold: covers about 80% of costs. Higher premiums, but lower expenses at the time of care. Suitable for those who use medical services frequently.
• Platinum: covers about 90% of costs. Highest coverage and higher monthly premium. Indicated for those with chronic conditions or who need regular treatments.

In addition to the metal category, plans vary according to the type of provider network. HMO requires the use of in-network doctors and a referral from a primary care physician. PPO offers more flexibility to see specialists and use out-of-network providers, with higher costs. EPO works like an HMO without the referral requirement, and POS combines features of HMO and PPO.

Enrollment Periods

Purchasing a plan through the Marketplace occurs during the Open Enrollment Period. For the 2026 plan year, the period was from November 1, 2025, to January 15, 2026. Those who enrolled by December 15, 2025, had coverage starting January 1, 2026.

Outside this period, enrollment is only allowed with a Qualifying Life Event. The most common events include marriage or divorce, birth or adoption, loss of previous coverage, moving to another state, significant change in income, and change in immigration status.

If you qualify due to one of these events, you generally have 60 days to enroll in a new plan. For immigrants who have just arrived in the U.S. with legal status, obtaining a visa or Green Card may qualify as a Qualifying Life Event.

Financial Limits in 2026

For the 2026 plan year, the federal government set the out-of-pocket maximum at $10,600 for individual coverage and $21,200 for family coverage. This means that after reaching this amount in covered expenses for the year, the insurer will cover 100% of the remaining costs.

This limit includes deductibles, copayments, and coinsurance, but does not include the plan’s monthly premiums. Knowing this cap is essential for the financial planning of any immigrant in the United States, as it ensures that a medical emergency does not turn into a financial catastrophe.

How to Purchase Your Plan

The process of purchasing through the Marketplace follows simple steps and can be done entirely online. The first step is to create an account at HealthCare.gov (or at the state marketplace, if applicable) and fill out the application with income, household composition, and immigration status information.

Next, the system automatically checks eligibility for subsidies and displays the plans available in your region. Compare costs, coverage, and provider networks before choosing the plan that best fits your profile and budget. After choosing, complete the enrollment and make the initial premium payment.

Coverage usually takes effect on the first day of the month following payment. Planning this step in advance is essential to avoid being without coverage during your first months in the United States, when access to healthcare is most vulnerable.

Victoria Harper

Editor-in-Chief

Meet the author

Leading journalism and editorial content at Visto n’ Visa, Victoria helps make immigration topics clear, trustworthy, and easy to understand. Her focus is on delivering useful, human, and relevant content for people exploring new paths abroad.