Facebook
Free Assistance* from Licensed Agents
Marketplace America.org Health Insurance

Affordable Health Insurance is Available to Millions of Americans! How Many Americans Get Marketplace Insurance for $0 or $50 or Less?

Map of the United States covered by a dollar sign. This sums up the state by state health insurance costs.
Topics Covered

Find out how many people are eligible for low-premium health insurance plans and who had access to health coverage for $50 or less per month.

The Affordable Care Act (ACA) has made low-cost health insurance more affordable and accessible for millions of Americans. In 2021, 42.5% of uninsured non-elderly adults in HealthCare.gov states had access to a $0 premium plan, and 56.8% had access to a plan for $50 or less per month.

For enrolled non-elderly adults in HealthCare.gov states, the percentage with access to a $0 premium plan was even higher, at 65.9%, and 78.1% had access to health coverage for $50 or less per month.

These statistics are a testament to the success of the ACA in expanding access to affordable health insurance. For many Americans, the ACA has made it possible to get the marketplace coverage they need without having to pay out-of-pocket costs on a monthly premium for health coverage.

In addition to making health insurance more affordable, the ACA has also made it more comprehensive. All ACA-compliant plans must cover a set of essential health benefits, including preventive care, prescription drugs, and mental health care. This means that Americans can be confident that they will have access to the care they need, regardless of their health status or income.

If you are uninsured or underinsured, the ACA can help you get the health insurance you need. You can visit Marketplace America to learn more about your options and apply for a plan.

Eligibility for a $0 monthly premium plan under the Affordable Care Act Premium Tax Credit

To qualify for a $0 premium plan under the Affordable Care Act (ACA), you must meet certain income requirements. The income limits vary by state, but they are generally lower than the income limits for eligibility for Medicaid.

To find out your insurance options and if you qualify for a $0 premium plan, you can use the ACA eligibility calculator on HealthCare.gov. This calculator will ask you for your income, household size, and state of residence to determine your eligibility for a $0 premium plan or other financial assistance.

Resources for learning more about eligibility and applying for marketplace coverage

  • HealthCare.gov: The official website of the ACA Marketplace, where you can learn more about your eligibility and apply for a plan.
  • Your state’s health insurance marketplace: Many states have their own health insurance marketplaces, which offer the same plans and financial assistance as HealthCare.gov.
  • Local health insurance providers: Many health insurance providers offer plans through the ACA Marketplace. You can contact local health insurance providers to learn more about their plans and eligibility requirements.

Here are some additional tips for applying for a $0 premium plan:

  • Apply during the Open Enrollment period: Open Enrollment is the period of time each year when you can enroll in an ACA health insurance plan. Open Enrollment for 2024 runs from November 1, 2023 to January 31, 2024.
  • Provide complete and accurate information on your application: When you apply for a $0 premium plan, you will need to provide information about your income, household size, and state of residence. Make sure to provide complete and accurate information so that you can be properly assessed for eligibility.
  • Update your application if your income or household size changes: If your income or household size changes during the year, you may need to update your application to ensure that you continue to be eligible for a $0 premium plan.

Get a Low Monthly Premium:

The Affordable Care Act (ACA) has made low-cost health insurance more affordable and accessible for millions of Americans.

In 2021, 42.5% of uninsured non-elderly adults in HealthCare.gov states had access to a $0 premium plan, and 56.8% had access to a plan for $50 or less per month. For enrolled non-elderly adults in HealthCare.gov states, the percentage with access to a $0 premium plan was even higher, at 65.9%, and 78.1% had access to a plan for $50 or less per month.

Marketplace America is a health insurance marketplace that offers a variety of plans from different insurance companies. You can compare plans and prices to find the plan that is right for you and your family. You can also get help enrolling in a plan from a trained customer service representative.

Visit Marketplace America today to learn more about their options and apply for a plan.

Zero-and Low-Premium Plan Availability by Plan Metal Tier

These table shows the availability of zero-dollar plans and low-premium plans among Marketplace-eligible uninsured non-elderly adults and the 2021 HealthCare.gov enrollee population by plan metal tier.

Zero- and Low-Premium Plan Availability and Selection in HealthCare.gov States by Metal Tier, 2021

Uninsured QHP Eligible Non-Elderly Adults Plan Availability by Plan Metal Tier (a,b)

2021 HealthCare.gov QHP Enrollees Plan Availability by Plan Metal Tier (b,c)

a. Data Source: American Community Survey, 2019
b. Data Source: HealthCare.gov Marketplace Plan Files for Coverage in 2021
c. Data Source: CMS/CCIIO MIDAS Plan Selections as of March 1, 2021
*Rounded to the nearest thousand
Note: Catastrophic plans and plan selections excluded from the analyses.

Uninsured non-elderly adults in HealthCare.gov states have access to affordable health insurance plans through the Marketplace.

  • 42.5% of uninsured non-elderly adults can access a zero-premium plan.
  • 56.8% of uninsured non-elderly adults can find a plan for $50 or less per month.
  • Low-premium plans are more common than zero-premium plans in all three metal levels.

Most 2021 HealthCare.gov enrollees have access to zero-premium or low-premium plans.

  • 65.9% have access to a zero-premium plan.
  • 78.1% have access to a low-premium plan.
  • 14.5% are enrolled in a zero-premium plan.
  • 43.4% are enrolled in a low-premium plan.

All results referring to “uninsured adults” in this brief are uninsured, non-elderly adults who are QHP-Eligible in HealthCare.gov states.

vi The actuarial value (AV) of a health plan is the average percentage of total costs of in-network essential health benefits (EHB) covered by the health plan.

The AV available to all QHP eligible individuals ranges from 60% for bronze plans, 70% for silver, 80% for gold, and 90% for platinum.

Zero-and Low-Premium Plan Availability by Demographic Characteristics

These table shows zero- and low-premium plan availability among the uninsured non-elderly adult population and current enrollees in the HealthCare.gov states by demographic characteristics.

Zero- and Low-Premium Plan Availability in HealthCare.gov States by Demographics, 2021

Uninsured QHP Eligible Non- Elderly Adults – Plan Availability (a,b)

2021 HealthCare.gov QHP Enrollees by Demographic Characteristics (b,c)

a. Data Source: American Community Survey, 2019
b. Data Source: HealthCare.gov Marketplace Plan Files for Coverage in 2021
c. Data Source: CMS/CCIIO MIDAS Plan Selections as of March 1, 2021

Note: Catastrophic plans and plan selections excluded from the analyses
*Rounded to the nearest thousand
‡Rural vs urban defined at the county level in the Marketplace files
§Race and ethnicity based on American Community Survey categories
#Excluded because of high % missing/unknown in HealthCare.gov data (42%) eligible individuals (generally household income 100%-250% FPL) silver cost-sharing reduction (CSR) plans are available which enhance AV from 70% to 73%, 87%, or 94% depending on income. AV is allowed to vary within a de minimis range by -4/+2 percentage points and expanded bronze plans that pay for at least one major service other than preventive services before the deductible or meet the requirements of high deductible health plans can vary by -4/+5 percentage points (45 CFR 156.140(c)). Catastrophic plans are excluded from all analyses.

†Consumers who do not request financial assistance when applying for coverage do not enter their household income information. A small number of consumers that do request financial assistance have missing household incomes due to a tax filing status that makes them APTC-ineligible or data anomalies. Lawfully present individuals with a household income less than 100% FPL who were denied Medicaid due to their immigration status can be APTC eligible (26 CFR 1.36B-2(b)(5)).
Uninsured QHP Eligible Non-Elderly Adults

Zero- and low-premium plans are more available to uninsured non-elderly adults in rural counties and to those with lower incomes.

  • 46.7% of uninsured non-elderly adults in rural counties have access to a zero-premium plan, compared to 41.6% of those in urban counties.
  • 60.6% of uninsured non-elderly adults in rural counties have access to a low-premium plan, compared to 56.0% of those in urban counties.
  • 90.1% of uninsured non-elderly adults with incomes between 138 and 150 percent of FPL could find a plan for zero premium, and all could find a plan for $50 or less per month.

Older (but non-elderly) uninsured adults are more likely to be able to find a low-cost plan.

  • 52.3% of uninsured non-elderly adults ages 55-64 have access to a zero-premium plan, and 62.0% have access to a plan for $50 or less per month.

Hispanic or Latino uninsured adults and Black Non-Latino uninsured adults are also more likely to have access to a low-cost plan.

  • 50.2% of Hispanic or Latino uninsured adult individuals have a zero-premium option and 64.5% could find a plan for $50 or less per month.
  • 45.1% of Black Non-Latino uninsured adults have a zero-premium plan available and 59.3% have a plan available for $50 or less.

Access to zero- and low-premium plans among current HealthCare.gov enrollees is highest for adults ages 18-24 and ages 55-64.

  • 73.4% of current enrollees ages 18-24 have access to a zero-premium plan, and 86.6% have access to a low-premium plan.
  • 70.9% of current enrollees ages 55-64 have access to a zero-premium plan, and 80.6% have access to a low-premium plan.

Current HealthCare.gov enrollees with the lowest incomes where APTCs are applicable (100-200 percent of FPL) had the greatest access to zero-premium plans (approximately 75 percent or higher) and the greatest access to low-premium plans (94 percent or higher).

Availability of zero-premium plans generally decreased at higher incomes, going from 98.4 percent among those with incomes between 100 and 138 percent FPL to 13.4 percent for those with incomes between 350 and 400 percent FPL (the exception being enrollees with income less than 100 percent FPL, who are often lack eligibility for APTCs and among whom only 43.4 percent have access to a zero-premium plan).

vii Per the ACA, most individuals with incomes under 100 percent FPL are not eligible for premium subsidies. Medicaid expansion was made optional for states by Supreme Court case Sebelius v. National Federation of Independent Business. The exception is for individuals that are not eligible for Medicaid because of immigration status; these individuals can have incomes less than 100 percent FPL or less than 138 percent FPL (non-expansion vs. expansion)and qualify for APTC (premium subsidies).

State-By-State Data

Zero- and Low-Premium Plan Availability by State

These table shows zero- and low-premium plan availability in HealthCare.gov states.

Uninsured QHP Eligible Non-Elderly Adults – Plan Availability by State (a,b)

2021 HealthCare.gov QHP Enrollees - Plan Availability by State (b,c)

a. Data Source: American Community Survey, 2019
b. Data Source: HealthCare.gov Marketplace Plan Files for Coverage in 2021
c. Data Source: CMS/CCIIO MIDAS Plan Selections as of March 1, 2021

Note: Catastrophic plans and plan selections excluded from the analyses
*Rounded to the nearest thousand

Uninsured QHP Eligible Non-Elderly Adults

  • Availability of zero-premium plans varies widely across HealthCare.gov states, from 0% to 66%.
  • Availability of low-premium plans also varies widely, from 27% to 74%.
  • State-to-state variability is due to the composition of the enrolled and uninsured population, as well as whether a state has expanded Medicaid.

2021 HealthCare.gov Enrollees

  • Access to zero- and low-premium plans also varies considerably by state for HealthCare.gov enrollees, ranging from 0 to 86% for zero-premium plans and 36% to 90% for low-premium plans.
  • Five states have no access to zero-premium plans for the uninsured or for enrollees.

More than half (56.8 percent) of uninsured non-elderly adults in HealthCare.gov states could find a zero- or low-premium plan.

Specifically, 42.5 percent may have access to a zero-premium plan and 56.8 percent may have access to a low-premium plan for $50 or less per month. This suggests that many uninsured individuals may be eligible for affordable coverage but may be unaware they have eligibility for coverage and/or financial assistance, may not know how to enroll in coverage, or may struggle with the complexity of insurance and/or the enrollment process.

However, it is important to note that premiums are only one component of health coverage costs.

Consumers should also consider out-of-pocket costs, such as deductibles, copays, and coinsurance. Zero- or low-premium plans may have higher consumer cost-sharing than higher premium plans. It is important for consumers to balance plan features when they select a plan.

Many of the zero- or low-premium plans are bronze plans with high deductibles.

Consumers need to be aware of out-of-pocket costs associated with different plan options. The median QHP deductibles – without cost-sharing reductions – for individuals in HealthCare.gov states by metal tier in 2021 are approximately $6,992 for bronze, $4,879 for silver, and $1,533 for gold. For those eligible for cost-sharing reductions (people with incomes between 100 and 250 percent FPL), these deductibles are typically substantially lower for silver plans. For example in 2021, comparable median deductibles for silver plans with cost-sharing reductions were $3,318 for 73 percent AV silver plans (available to those with income of 200 and 250 percent FPL), $620 for 87 percent AV (available to those with income between 150 and 200 percent FPL), and $74 for 94 percent AV (available to those with income between 100 and 150 percent FPL).

Access to zero- and low-premium plans varies across demographic groups.

Historically, policies, laws, and practices have limited health insurance options for communities of color. The uninsured population disproportionately includes Black and Latino individuals, younger adults, individuals living in rural areas, and individuals with incomes between 100-400 percent of FPL. The uninsured population is also more likely to defer or forgo needed health care, resulting in higher potential for poor health outcomes.

It is important to address the barriers that prevent uninsured individuals from accessing affordable health coverage.

This includes raising awareness of the availability of zero- and low-premium plans, providing assistance with enrollment, and simplifying the enrollment process. It is also important to address the underlying inequities that contribute to the high number of uninsured individuals, such as racial and ethnic disparities in income and access to health insurance.

ix Certain preventive services, such as an annual check-up and diagnostic screenings, are typically available before the deductible is met and with no cost-sharing, i.e. these services are accessible to a person before they have to pay toward their deductible.

Zero- and low-premium plans are more available to Black, Latino, and Native American adults who lack insurance and could qualify for APTCs.

This suggests the ACA can help address disparities in health coverage in these populations.

Rural areas have slightly higher access to zero- and low-premium plans than urban areas.

This may be because average income in rural areas is lower and more individuals qualify for larger subsidies.

The American Rescue Plan (ARP) increases and expands eligibility for the ACA Marketplace premium subsidies.

This will make zero- and low-premium plans more available to many consumers and uninsured individuals.

The ARP also includes unemployment provisions that allow individuals who received unemployment compensation in 2021 to be deemed to have an income not in excess of 133 percent FPL for the purpose of calculating eligibility for APTCs and cost-sharing reductions.

This will further increase availability of zero- and low-premium plans.

There is evidence that zero-premium and low-premium plan availability encourages uninsured people to enroll in the Marketplace.

Increasing consumer awareness of such plans is an important part of the strategy to increase health insurance coverage.

The ARP includes provisions that build upon the ACA, including enhancing and expanding Marketplace subsidies.

These changes will further improve the affordability of coverage for uninsured individuals as well as those already enrolled in Marketplace health plans, likely leading to more individuals enrolling in health insurance coverage in the coming months.

Appendix: Detailed Methodology

Factors Applicable to Both the Uninsured and HealthCare.gov Enrollee Analyses

  • Qualified Health Plans (QHPs) must offer a comprehensive package of benefits, known as Essential Health Benefits (EHBs).
  • QHP premiums and the EHB percent of premium are available at the county-level.
  • We assume plans cover all zip codes in a county.

Availability of Zero-Premium and Low-Premium Plans Among Currently Uninsured QHP Eligibility

  • We identified non-elderly adults (ages 18 to 64) who lack health insurance and are likely QHP eligible.
  • We calculated whether a 2021 Marketplace health insurance plan, net of APTC, could have been purchased for zero dollars or for $50 or less per month.
  • We restricted the uninsured portion of the analysis to non-elderly adults (ages 18 to 64), with household incomes at or above 100% FPL, who are both uninsured and potentially QHP eligible.

Calculation of Maximum Premium Tax Credits

  • The percent of household income that each respondent must pay to purchase a 2021 benchmark plan is determined by that respondent’s income as a percentage of the FPL.
  • The expected family contribution (EFC) towards premiums is that percentage multiplied by family income.
  • We allocate the EFC among each uninsured person (age less than 65) in the family using the relevant age curve used for their state.

Calculation of the Premium Tax Credit

The premium tax credit (PTC) is calculated by subtracting the expected family contribution (EFC) from the essential health benefits (EHB) premium of the benchmark plan in the respondent’s county. If the difference is less than zero, the PTC is set to zero. The PTC is also set to zero for respondents with income as a percentage of poverty that is greater than 400% or less than 138% (100% in states that did not expand Medicaid as of January 2021).

Calculation of the Lowest Cost Premium Net of APTC

For each metal level and county, the two lowest cost plans based on the age 21 total premium are found: 1) the lowest cost plan among all plans, and 2) the lowest cost plan with an EHB percent of premium equal to 100%.

For each respondent and metal level, the age 21 premiums are adjusted according to the respondent’s age and the relevant age factor for the respondent’s state. Net premiums are then found by taking the difference between each plan’s EHB premium and the respondent’s PTC. If the PTC is greater than the relevant plan’s EHB premium, the difference is set equal to $0 and the final net premium is set equal to the non-EHB portion of the plan’s premium (which is $0 for plans with an EHB percent of premium equal to 100%). The final net lowest cost premium for each respondent and metal level is equal to the lesser of the two net premiums for the metal level.

Availability of Zero-Premium Plans and Low-Premium Plans

A respondent is determined to have a zero-premium plan available if the net lowest cost premium is $0. A respondent is determined to have a low-premium plan available if the net lowest cost premium is $50 or less per month. Catastrophic plans are excluded from the analysis.

Estimation of Counts

Counts of uninsured non-elderly adults, percentages of uninsured non-elderly adults with access to a zero-premium plan, and percentages of non-elderly adults with access to a low-premium plan are estimated using the Census person-level weights to account for assignment of respondents to multiple counties. The counts and percentages are calculated for HealthCare.gov states in aggregate, by demographic characteristics, and at the state level.

Availability of Zero Premium and Low Premium Plans Among QHP Enrollees in HealthCare.gov States

Data on 2021 Marketplace selections in HealthCare.gov states using active plan selections as of March 1, 2021 are used. An active plan selection is one that is non-cancelled with an end date of December 31, 2021. After excluding catastrophic plan selections, there are a total of 7,968,000 consumers with plan selections. From these data, attested household income, county and state of residence, age, the individual- and policy-level gross premium, policy-level premium net of applied APTC (net premium), and maximum amount of APTC available to the household are used.

Calculation of the Lowest Cost Premium Net of Premium Tax Credits

The calculated maximum APTC amount for a given household is used to determine the final premiums after applying APTC. For each plan available to a household, the net premium is calculated as the difference between the plan’s EHB premium for all household members and the household’s maximum available APTC. If the maximum APTC is greater than the relevant plan’s EHB premium, the difference is set equal to $0 and the final net premium is set equal to the non-EHB portion of the plan’s premium for all household members (which is $0 for plans with an EHB percent of premium equal to 100%). The lowest net premium is then found for each household and metal level.

Distribution of the Net Premium Amount Among Household Members

The net premium amount is distributed among household members based on each member’s individual gross premium amount, which aligns with the relevant age curve except in cases of tobacco rating. When a policy includes more than 3 children such that some children are not rated, the total child rate is distributed among all children younger than 21 years-old. Tobacco users are included and plan premiums are calculated using tobacco rates when they exist.

Calculation of Current Plan Selection Premiums Net of Premium Tax Credits

The calculated policy-level premium net of APTC is taken and distributed to policy members based on each member’s individual gross premium amount, as described above. Consumers have the option to use less than their maximum available APTC; consumers may opt to do so if they expect their income to rise during the year and want to avoid paying back PTC when filing taxes. For current plan selection premiums, the consumer elected APTC amounts

Sources

  1. Assistant Secretary For Planning And Evaluation (ASPE). Access to Marketplace Plans with Low Premiums on the Federal Platform

Need health insurance?

Call our Marketplace Call Center for free assistance* from licensed health agents.

Get a free health insurance quote today!

*Agents may be compensated based on enrollment in your health plan by the insurance company.