When enrolling a client in an ACA Marketplace plan, understanding plan network types, metal levels, and available financial assistance helps agents match clients to the right plan in MyMFG.

For details on Catastrophic plan eligibility and APTC repayment rules, see Catastrophic Health Plans and APTC Repayment — Frequently Asked Questions.

ACA Marketplace plans are offered in three main network types. The network type determines where clients can receive care and whether they need referrals to see specialists.

HMO plans require clients to choose a primary care physician (PCP) who coordinates all care. Clients must stay within the plan's network of providers except in emergencies. Referrals from the PCP are required to see specialists. HMO plans generally have lower monthly premiums and lower out-of-pocket costs than PPO plans. HMO plans are a good fit for clients who want lower costs and do not need out-of-network access.

PPO plans allow clients to see any doctor or specialist without a referral, including out-of-network providers. Out-of-network care is covered but at a higher cost-sharing rate than in-network care. PPO plans generally have higher monthly premiums. PPO plans are a good fit for clients who want flexibility in provider choice or who have established relationships with specific physicians.

EPO plans require clients to use the plan's network of providers, similar to an HMO. However, EPO plans do not require a primary care physician or referrals to see specialists. Out-of-network care is not covered except in emergencies. EPO plans are a good fit for clients who want specialist access without needing a referral but are comfortable staying within a defined network.

ACA Marketplace plans are grouped into five metal levels: Bronze, Silver, Gold, Platinum, and Catastrophic. Each metal level represents the average percentage of covered healthcare costs the insurance plan pays. The remaining percentage is the client's share through deductibles, copays, coinsurance, and out-of-pocket maximums. Metal level percentages are averages — always verify the actual plan details shown in MyMFG.

The maximum out-of-pocket (MOOP) limit changes annually — always verify the current limit at healthcare.gov or within the plan details shown in MyMFG.

Bronze plans have the lowest monthly premiums but the highest cost-sharing when clients use healthcare services. Best for clients who are generally healthy, rarely need medical care, and want to protect against worst-case medical expenses. Starting January 1, 2026, any Bronze plan available on the Exchange qualifies as a High Deductible Health Plan (HDHP) and is HSA-eligible.

Silver plans have moderate monthly premiums and moderate cost-sharing. Silver plans are the only metal level eligible for Cost-Sharing Reductions (CSRs). Clients who qualify for CSRs must enroll in a Silver plan to receive CSR savings — CSRs are not available on Bronze, Gold, or Platinum plans. Clients with income between 100% and 200% FPL often receive the most significant savings through Silver plan CSRs.

Gold plans have higher monthly premiums but lower cost-sharing when clients use healthcare services. Deductibles for Gold plans are typically low. Best for clients who use healthcare services regularly and prefer predictable out-of-pocket costs over lower monthly premiums.

Platinum plans have the highest monthly premiums and the lowest cost-sharing. Deductibles are the lowest of all metal levels. Best for clients who use a considerable amount of healthcare and are willing to pay a higher monthly premium in exchange for minimal out-of-pocket costs at the time of service. Platinum plans are not eligible for CSRs.

Catastrophic plans have very low monthly premiums and very high deductibles. They cover three primary care visits per year before the deductible is met, plus all Essential Health Benefits after the deductible is reached. Generally only available to clients under age 30, or clients 30 and older who qualify for a hardship or affordability exemption. Starting January 1, 2026, Catastrophic plans also qualify as HDHPs and are HSA-eligible.

APTC is a tax credit that reduces a client's monthly premium. Eligibility is based on projected annual household income. Income changes during the year may impact the final credit amount at tax time.

CSR lowers a client's out-of-pocket costs — deductibles, copayments, and coinsurance — on a Silver plan. CSR eligibility is based on household income between 100% and 250% of the Federal Poverty Level (FPL). The lower the income within that range, the greater the CSR savings. Clients who qualify for CSR must enroll in a Silver plan to receive the benefit — enrolling in Bronze, Gold, or Platinum means CSR does not apply even if the client is eligible.

During the quote process in MyMFG, you can view the client's CSR level, their FPL percentage, and their estimated APTC. This information appears within the quote results and should always be reviewed before finalizing plan selection.

An HSA is a tax-advantaged savings account clients can use to pay for qualified medical expenses such as deductibles, copays, coinsurance, and other out-of-pocket costs. Clients must be enrolled in an HSA-eligible HDHP to open and contribute to an HSA. For plan year 2026, all Bronze and Catastrophic plans available on the Exchange qualify as HDHPs and are HSA-eligible. HSA balances roll over from year to year, allowing clients to build reserves for future healthcare expenses. Clients can find HSA-eligible plans in MyMFG by filtering for plans that indicate HSA eligibility in the plan details.

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 a client's Marketplace subsidy eligibility.

For additional help please contact Producer Support, which is available by chat directly from your account, by phone at (866) 568-9649, or by email at [email protected].