A Qualified Health Plan (QHP) is a private insurance plan certified by the Health Insurance Marketplace® (or State Exchange) that meets Affordable Care Act (ACA) standards, including providing essential health benefits and adhering to cost-sharing limits. QHPs cover pre-existing conditions and offer premium tax credits to eligible individuals.

HealthCare.gov

Key Features of Qualified Health Plans

Essential Health Benefits: All QHPs cover 10 mandatory areas, including emergency services, prescription drugs, mental health services, maternity care, and preventive care.

Certification: They are certified by the Marketplace, licensed in their state, and adhere to ACA regulations.

Cost-Sharing Limits: They have established caps on deductibles, copayments, and out-of-pocket maximums.

Financial Assistance: Individuals purchasing a QHP through the Marketplace may qualify for Advance Premium Tax Credits (APTC) to lower monthly premiums.

info.nystateofhealth.ny.gov

Getting a Qualified Health Plan

Enrollment: You can enroll during the annual Open Enrollment Period or during a Special Enrollment Period due to qualifying life events (e.g., job loss, marriage).

Marketplace Availability: QHPs are sold through the federal or state-run Marketplace, often called "exchanges".

Types: They come in different tiers (Bronze, Silver, Gold, Platinum) based on how you and the plan share costs