Frequently Asked Questions
How many counties and states does PlainHealthPlan cover?
PlainHealthPlan covers 2,055 counties across 30 states that use the federal HealthCare.gov marketplace. States with their own ACA exchanges (such as California, New York, and Massachusetts) are not included because CMS does not publish plan data for those states in the federal PUF dataset.
What are the ACA metal levels?
ACA plans are sold in four metal tiers that describe the cost-sharing split between you and the insurer: Bronze (you pay roughly 40% of costs), Silver (30%), Gold (20%), and Platinum (10%). Lower-metal plans have lower premiums but higher out-of-pocket costs when you use care. Premium Tax Credits are benchmarked to the second-lowest-cost Silver plan in your county.
What is a benchmark premium?
The benchmark premium is the second-lowest-cost Silver plan available in your county. Federal Advanced Premium Tax Credits (APTC) are calculated based on this benchmark, your subsidy is the difference between the benchmark premium and a capped percentage of your income. Choosing a lower-cost plan than the benchmark means your subsidy covers more of your premium.
Why is the age-27 rate used as the reference?
The ACA requires that premiums for older enrollees not exceed three times the premium for younger enrollees. Age 27 is the CMS standard reference age for public data publication and is widely used in the industry for plan comparison. Actual premiums vary by age, a 60-year-old pays significantly more than the displayed age-27 rate.
Can I enroll in a plan through PlainHealthPlan?
No. PlainHealthPlan is a data research tool only. To enroll in a marketplace plan, visit HealthCare.gov (or your state marketplace) during Open Marketplace period (typically November 1 – January 15) or during a Special Enrollment Period if you qualify.
How often is the data updated?
CMS releases updated Marketplace PUF data annually before each Open Marketplace period period. PlainHealthPlan currently includes data from plan years 2022 through 2026. We update when new plan year data becomes available.
Is PlainHealthPlan affiliated with CMS or HealthCare.gov?
No. PlainHealthPlan is not affiliated with CMS, HealthCare.gov, or any government agency or insurance company. We are an independent data portal providing public information in a more accessible format.