Consumer resources

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HealthSherpa is a simple way to compare plans and enroll individuals and families in Federal Marketplace health insurance available through the Affordable Care Act (ACA). It is free to use HealthSherpa to shop plans and fully complete your enrollment application. You can typically make your first insurance payment directly through HealthSherpa, with subsequent monthly payments made directly to your insurance company, but there is no cost to use the HealthSherpa platform to shop or enroll.

HealthSherpa is a private enrollment platform that helps you compare options and complete enrollment, but it is not an insurance company. HealthSherpa also has a team of dedicated Consumer Advocates who can assist you with your enrollment journey. To reach them please call 855-772-2663

No, it is a private platform that helps you shop for and enroll in Marketplace health insurance plans, and it is free to use for your enrollment.

Only ACA-compliant plans are available through HealthSherpa.

Health Insurance Marketplace plans are offered through several types of provider networks: HMO, PPO, EPO, and POS. Each network type determines how you access care, which doctors you can see, and how much you’ll pay.

Consumers may be able to buy Marketplace coverage if they:

Yes. Consumers must be a U.S. citizen, U.S. national, or have an eligible lawful presence status and must physically live in the United States (and intend to reside here) in order to purchase Marketplace coverage.
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A U.S. citizen living abroad does not meet the residency requirement and therefore cannot enroll in a Marketplace plan until they return to live in the U.S.

If your employer offers health insurance you can still enroll in a Marketplace plan, but you may not qualify for subsidies (premium tax credits) unless your job-based plan is unaffordable or does not meet minimum value.

A plan is considered unaffordable if the share you pay for coverage is more than a set percentage of your household income. For the 2026 plan year, the affordability limit is 9.96%.

In the past, affordability was only based on the cost of coverage for the employee. Now, Marketplace rules also look at the cost of coverage for your spouse and children. This means family members may qualify for savings even if the employee does not. You may also still qualify for Marketplace coverage if:

To see if you or your family might qualify for Marketplace savings:

The Marketplace will check this when you apply, but having these numbers ready makes it easier to compare.

A subsidy is government help that lowers how much you pay for Marketplace health coverage each month. The two types of subsidies offered through the Affordable Care Act are:

Oftentimes, your tax-filing status can affect your eligibility for subsidies. Check with a tax preparer or IRS guidance to confirm which filing status you can use.

When applying for health coverage, it's important to include everyone in your "tax household" on your application. This includes the tax filer, their spouse, and any tax dependents, even if some members don't require coverage. Information about your entire tax household is needed to determine your eligibility for financial assistance, such as tax credits and cost-sharing reductions.

Be sure to include:

You'll need to provide your estimated Modified Adjusted Gross Income (MAGI) for the application year. This includes your MAGI, your spouse's, and any dependents who are required to file taxes. Learn more about what to include as income here.

To calculate your MAGI, begin with your Adjusted Gross Income (AGI) and then add back any untaxed income. This untaxed income can include tax-exempt interest, non-taxable Social Security benefits, and certain foreign income. Importantly, do not include Supplemental Security Income (SSI), child support, gifts, or veteran's disability payments.

When applying for financial assistance, be sure to include the following income sources:

When applying for financial assistance, do not include the following income sources:

When applying for coverage, estimate your household's expected income for the upcoming year, not the previous one. If your income fluctuates, estimate as accurately as possible. Be sure to report any changes throughout the year to prevent tax-time discrepancies.

If you need help with your estimate, use your pay stubs to determine your "federal taxable wages" and multiply this by the number of paychecks you anticipate receiving in the year. Remember to modify your income based on any expected changes, such as bonuses or raises.

When you apply for Marketplace coverage and receive help paying your monthly premium through an Advance Premium Tax Credit (APTC), your eligibility and savings are based on your estimated household income for the year.

Keeping this information accurate and up to date is essential to avoid surprise bills, maintain eligibility for savings, and ensure you stay in good standing with the IRS.

Important items to consider:

Consumers can enroll in heath coverage during the annual Open Enrollment Period (OEP) for Affordable Care Act (ACA) plans. For states who use the Federally-Facilitated Marketplace (FFM), OEP begins on November 1st, 2025 and ends on January 15th, 2026. Note: State-Based Marketplaces (SBM) can have different Open Enrollment dates. See more information on Marketplace type by state here.

Outside of OEP, consumers can enroll in ACA coverage or change ACA plans as long as they qualify for a Special Enrollment Period (SEP). Note: SEP enrollments can be submitted for each month of the year as long as the consumer has a valid Qualifying Life Event (QLE).

Common QLEs include:

If you are not sure whether you qualify for an SEP, ask yourself "Has something happened in the last 60 days, or will happen in the next 60 days, that changes my health coverage?" If yes, you may be eligible for a SEP. If not, you may still have year‑round options like Medicaid or CHIP, depending on your income and state.

You can run a quote and apply for Marketplace health coverage directly through HealthSherpa. The process is simple, free to use, and shows the same plans and prices you’d see on the official Marketplace.

After successfully submitting an application, you'll receive an email from HealthSherpa.

If the Marketplace needs proof (for example, of income, citizenship, or loss of coverage), you’ll see a “Followups” box at the top of your dashboard where you can upload documents.

Document reviews usually take 5–10 business days for loss of coverage, and up to 30 business days for income or citizenship/immigration. Once your documents are approved, the payment button will appear on your dashboard.

Pay your first premium directly to your insurance company to activate coverage. If your payment is made after the 1st, your coverage still backdates to the 1st of the month, and you can request reimbursement for eligible care during that time.

You can check the status of your Marketplace application any time directly from your HealthSherpa dashboard. This is the best way to see if your application was submitted successfully, whether documents are still needed, and what steps come next. Steps to check your application status:

Your status will show one of the following:

If your status says “Follow-Up Required” or “Pending Documents,” make sure to upload the requested items as soon as possible. Processing can take 5–10 business days for most documents and up to 30 days for income or citizenship verification.

Once your application is complete and any required documents are approved, your insurance company will finalize your enrollment. You’ll receive information about your plan and payment instructions directly from them.

If your income, household size, or address changes, it’s important to update your Marketplace application as soon as possible. These updates can affect your eligibility for savings and coverage options. You should update your application within 30 days of any major life change, such as:

Steps to update your application:

Once you finish, your new eligibility results will appear, and you can confirm or adjust your plan if needed.

Some states run their own marketplaces outside of Healthcare.gov to enroll in Affordable Care Act plans. In those states, browsing or enrollment may happen through the state’s website, or we may connect you with a licensed agent by phone to complete your application. In short:

For plan year 2026, states with their own Marketplaces include: California, Colorado, Connecticut, District of Columbia, Georgia (but can be enrolled directly through HealthSherpa), Idaho, Illinois, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Washington. Arkansas and Oregon are state-based marketplaces that still use HealthCare.gov for enrollment and can enroll directly through HealthSherpa.

For plan year 2027, The federal Open Enrollment window will shorten and end on December 31 starting with 2027 coverage. Additionally, Oregon is moving to a full state-based marketplace platform for 2027 coverage, so Oregon residents will enroll directly through the state’s system beginning with Open Enrollment in fall 2026.

Yes. Under the Affordable Care Act (ACA), health insurance companies cannot deny you coverage or charge you more because of a pre-existing condition. This rule applies to all Marketplace plans and most individual and employer-based plans. HealthSherpa applications will not ask questions about pre-existing conditions during the application process.

A pre-existing condition is any health issue you had before your coverage starts; such as asthma, diabetes, cancer, pregnancy, or mental health conditions.

Marketplace plans must cover treatment for pre-existing conditions from the day your coverage starts. Preventive services (like check-ups, vaccines, and screenings) are covered with no cost to you, even if you already have a condition. You cannot be charged more or have benefits limited just because of your health history. Pregnancy is always covered, even if you were pregnant before applying.

The Affordable Care Act (ACA) does not mandate coverage for infertility services.

Some states require that specific plans include coverage for certain infertility treatments, such as the diagnosis and treatment of infertility, but not the in-vitro process. When shopping for health coverage, if you require these services, it's important to review plan details regarding coverage and out-of-pocket costs for infertility care.

The ACA requires individual and small-group health plans to cover 10 essential health benefits (EHB), but assisted reproductive technology is not categorized as an EHB unless a state explicitly chooses to include it.

Marketplace plans: Private health insurance plans, often with income-based subsidies available to lower monthly premiums and out-of-pocket costs.

Medicaid: A government health program providing free or low-cost coverage for people with low income, based on household income and eligibility rules set by states and the federal government.

CHIP (Children’s Health Insurance Program): A government program that provides low-cost health coverage for children (and in some states pregnant individuals) in families who earn too much for Medicaid but can’t afford private insurance.

Medicare: A federal health insurance program primarily for people age 65 and older, and for some younger people with certain disabilities or serious medical conditions.

If you were denied Medicaid and do not qualify for Marketplace subsidies, you still have several ways to get covered or lower costs.

Coverage options include:

Additional considerations:

The Children’s Health Insurance Program (CHIP) is a state-run program that provides free or low-cost health coverage for children, and in some states, for pregnant people. You can apply any time of year, and if you qualify, coverage can begin right away.

While CHIP benefits vary by state, all states offer comprehensive coverage, including:

States may provide more CHIP benefits. Learn more about covered services in your state.

Children in families with incomes too high for Medicaid but too low to afford private coverage. Some states also cover pregnant people through CHIP. Each state sets its own income limits and rules.

CHIP is funded by both states and the federal government and many families pay no premium for CHIP. If your state charges premiums or copays, the total cost is capped at no more than 5% of your family’s annual income.

Apply through your state’s Medicaid or CHIP agency, or start at HealthCare.gov and you’ll be directed to your state program. You can also apply through the Marketplace Call Center by phone.

Additionally, when you submit an application through HealthSherpa, you will be screened for both Marketplace coverage as well as Medicaid/CHIP.

No, children who qualify for CHIP or Medicaid are generally not eligible for Marketplace subsidies. While they may be included on a family Marketplace plan, their portion of the premium does not qualify for financial assistance, though other eligible family members may still receive premium tax credits.

An exception applies in states with a waiting period before CHIP coverage begins, during which children may qualify for premium tax credits; once the waiting period ends and CHIP coverage is available, subsidy eligibility stops.

Many families choose to have parents covered by a Marketplace plan with premium tax credits, while their children are covered by CHIP.

Medicare is a federal health insurance program for people age 65 and older, and for some younger people with certain disabilities, End-Stage Renal Disease (ESRD), or ALS. More than 60 million people are enrolled in Medicare.

Most people qualify at age 65, but some qualify earlier due to a qualifying disability, ESRD, or ALS. Individuals who already receive Social Security or Railroad Retirement Board benefits are often enrolled automatically.

Medicare is divided into four parts, each covering different types of health care services:

Medigap (Medicare Supplement) plans are sold by private insurers to help cover out-of-pocket costs for Original Medicare (Parts A and B) and cannot be used with Medicare Advantage plans.

Consumers can enroll in or make changes to Medicare coverage during specific enrollment periods throughout the year:

If you have a Marketplace plan and later become eligible for Medicare, your Marketplace coverage will not be cancelled automatically. You’ll need to take action to end it once your Medicare coverage begins.

When your Medicare coverage is about to start, you will need to update your Marketplace application:

You are not eligible for subsidies once you have Medicare Part A coverage.

Form 8962 is the IRS Premium Tax Credit (PTC) form used to reconcile or claim premium tax credits for a Marketplace health plan. The Marketplace calculates any advance premium tax credits (APTC) you received during the year based on your estimated income, and Form 8962 compares that estimate to your actual household income at tax time using information from Form 1095-A. This reconciliation determines whether you received the correct amount of help, need to repay excess credits, or are entitled to additional credits as a refund.

Even if you had Marketplace coverage but did not receive APTC, you may still use Form 8962 to claim the credit when filing your tax return, and filing it is required to remain eligible for future Marketplace subsidies.

Form 1095-A is a tax form you receive if you or anyone in your household had health coverage through the Marketplace during the year. It shows the months you were covered, the cost of your plan, and any advance premium tax credits applied to your premiums.

You use the information on Form 1095-A to complete IRS Form 8962 when filing your federal tax return to reconcile or claim premium tax credits. If the form contains errors - such as incorrect coverage months, premium amounts, or missing household members - you should contact the Marketplace at 1-800-318-2596 to request a corrected form, and keep both versions with your tax records, since reconciliation is required to remain eligible for future financial assistance.

To access your 1095-A form using HealthSherpa:

COBRA is a federal law - the Consolidated Omnibus Budget Reconciliation Act - that allows you to temporarily keep your employer-sponsored health insurance after losing your job or experiencing a reduction in work hours.

Under COBRA, you stay on the same health plan but must pay the full premium yourself, including the portion your employer previously paid, plus a small administrative fee. Coverage typically lasts up to 18 months, with possible extensions to 29 months for disability or up to 36 months for certain family events.

You may choose either COBRA or a Marketplace plan (not both), and while Marketplace coverage may be more affordable if you qualify for subsidies, enrolling in COBRA generally limits your ability to switch to a Marketplace plan until Open Enrollment or when COBRA ends.

It depends on the timing and circumstances. During Open Enrollment, you can enroll in a Marketplace plan and qualify for subsidies (if eligible), even if you are voluntarily canceling COBRA.

Outside Open Enrollment, you can enroll in a Marketplace plan only if you are within 60 days of losing your job-based coverage or if your COBRA coverage is ending; voluntarily ending COBRA early does not create a Special Enrollment Period.

If you enroll in a Marketplace plan, your COBRA coverage must end when your Marketplace coverage begins.

Creating a HealthSherpa Consumer account is quick and simple, and it gives you access to your Marketplace application, plan details, and enrollment documents all in one place. HealthSherpa accounts can only be created after submitting an application, not before.

To create your HealthSherpa Consumer account:

Once your account is set up, you can log in anytime to view your application, track your enrollment, upload documents, and make updates as needed.

To reset your password for your HealthSherpa Consumer account:

If this is your first time logging in, you’ll also use these steps to set up a password.

If you don't see the email mentioned in step 4:

If you can’t remember which email you used to create your HealthSherpa account, there are a few ways to regain access.

If you are still unable to identify the email address used for your HealthSherpa Consumer account, contact our Consumer Advocate team. After verifying your identity, our Consumer Advocate team will be able to locate your account, and walk you through how to reset your password or update your login details.

If you no longer want to keep your HealthSherpa account, you can request that it be deleted. Once deleted, you will lose access to your dashboard, application details, application & enrollment history, uploaded documents, and any saved plan information.

For security reasons, account deletion requires a formal request and identity verification. Please follow these steps:

Deleting your account does not cancel any Marketplace plan or coverage. To end coverage, you’ll need to contact the Marketplace or your insurance company directly. If you want to apply again later, you’ll need to create a new account.

If your contact information has changed, update it so you don’t miss important notices about your application, documents, or coverage. To update your email or phone number

If you no longer have access to the email address used for your HealthSherpa Consumer account, contact our Consumer Advocate team. After verifying your identity, our Consumer Advocate team will be able to locate your account, and walk you through how to update your login details.

When you apply through HealthSherpa, we try to verify your identity automatically with the Marketplace. Sometimes this cannot be completed right away, which leads to failed identity proofing. If this happens, your application pauses until your identity is verified; your enrollment cannot be sent to your insurance carrier until your identity is confirmed.

If consumer identity verification fails:

Once your identity is verified, your HealthSherpa application updates automatically and moves forward for processing. You will see confirmation in your HealthSherpa account and receive a notice by email.

If your identity proofing attempt through HealthSherpa does not go through, you’ll need to complete your ID verification directly through HealthCare.gov for Federal Marketplace states or through Georgia Access if you are in Georgia.

Quick tips for faster approval

Once your ID is verified, you can return to HealthSherpa to finish your application and plan selection.

Yes. Consumers can call HealthSherpa Consumer Advocates at 855-772-2663 for questions or help, open Monday - Friday 6:00am - 4:00pm PT.