ACA Plan Selection Guide — Helping Clients Choose the Best Marketplace Plan

A key part of an agent’s role is helping clients understand the many components of an ACA Marketplace plan so they can make informed decisions about their health coverage. Familiarity with common terms, cost structures, and available resources can make these conversations more effective and meaningful.

This guide is designed to clarify important concepts that frequently come up during plan discussions in MyMFG.

Premiums
The premium is the monthly amount required to maintain coverage. Many Marketplace clients may qualify for reduced premiums through Advance Payments of the Premium Tax Credit (APTC). Understanding how this credit impacts the final monthly cost can help provide clearer cost expectations.

Deductibles
A deductible is the amount a client pays before the plan begins covering certain services. Plans may include separate deductibles for medical services and prescriptions, and costs can vary depending on whether care is received in-network or out-of-network. It’s useful to understand what expenses apply toward meeting a deductible.

Out-of-Pocket Costs
Out-of-pocket costs include deductibles, copayments, and coinsurance. These costs can vary significantly between plans. Reviewing potential annual expenses alongside expected healthcare usage can provide helpful context when evaluating options.

Advance Premium Tax Credit (APTC)
APTC is a tax credit that reduces a client’s monthly premium. Eligibility is based on projected annual household income reported on the Marketplace application. Because income can change, it’s important to be aware that adjustments during the year may impact the final credit amount at tax time.

Cost-Sharing Reductions (CSR)
CSR lowers out-of-pocket costs such as deductibles, copayments, and coinsurance. Eligibility is income-based and requires enrollment in a Silver plan. While APTC can be applied to multiple metal levels, CSR benefits are only available through Silver plans.

Bronze Plans
Typically feature lower monthly premiums with higher out-of-pocket costs. These plans are often associated with coverage for unexpected or high-cost medical events. As of January 1, 2026, Bronze plans qualify as High Deductible Health Plans (HDHPs) and are HSA-eligible.

Silver Plans
Offer a balance between premiums and out-of-pocket costs. They are also the only plans eligible for Cost-Sharing Reductions (CSR), which can significantly lower costs for qualifying clients.

Gold Plans
Generally have higher premiums and lower out-of-pocket costs. Deductibles are often lower, which may make costs more predictable when care is used.

Platinum Plans
Have the highest monthly premiums and the lowest out-of-pocket costs. These plans begin covering expenses sooner due to low deductibles.

Catastrophic plans are designed to provide protection against very high medical costs and include coverage for three primary care visits before the deductible is met.

Beginning in 2026, hardship exemptions allow broader eligibility for Catastrophic plans regardless of age for those who do not qualify for APTC or CSR. These plans are also considered HSA-eligible.

HSAs allow clients to set aside pre-tax funds for qualified medical expenses such as deductibles, copayments, and coinsurance. These accounts are paired with HSA-eligible (HDHP) plans and offer the ability to roll over funds year to year.

HRAs are employer-funded arrangements that reimburse employees for premiums and/or medical expenses. Types include Individual Coverage HRAs (ICHRAs) and Qualified Small Employer HRAs (QSEHRAs). Availability of an HRA may impact Marketplace subsidy eligibility.

For questions related to ACA plan details or quoting in MyMFG, please send us a message via chat, or send us an e-mail to [email protected].
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