Enhance Health

Qualified Health Plans

Qualified Health Plans can be difficult to understand, but we’re here with all the answers. We’ll cover what these plans are, the qualifying criteria, how they compare with other healthcare plans, and how to enroll. Read on to find out more.

What Are Qualified Health Plans?

Qualified Health Plans, or QHPs, are health insurance plans that meet criteria set by the government or a regulatory body.

The term is used in the context of the Affordable Care Act, also known as Obamacare. Under this Act, individuals and families are entitled and required to be covered by a health insurance policy. This can be through their employer, a government program, or a private purchase through the Health Insurance Marketplace. 

The Health Insurance Marketplace is a government-run service that helps citizens choose alternative insurance plans. It eliminates the need to use employer-mandated plans and gives the unemployed a place to access health insurance.

The Marketplace is federally facilitated, and states have the option to establish their own Marketplaces.

Qualified Health Plans are those registered on the Health Insurance Marketplace. The plans must follow established limits on copayments, deductibles, and out-of-pocket maximums.

Qualifying Criteria For Qualified Health Plans

Not everybody qualifies for a Qualified Health Plan. Here are the qualifying criteria:

  • You must be a lawful resident or citizen of the United States.
  • You must enroll during the annual Open Enrollment Period. This is usually between November 1 and December 15, but the dates may change yearly. Life events such as getting married, losing other health coverage, or moving to a new area can qualify you for a Special Enrollment Period outside of this.
  • Your income must be below the specific income threshold for that particular year. These change over time, so check the current guidelines to determine if you qualify for financial help.
  • You must not be eligible for affordable employer-sponsored health insurance. 

The History Of Qualified Health Plans

Qualified Health Plans emerged when President Obama signed the Affordable Care Act in 2010. The Act aimed to expand access to affordable health insurance for all Americans.

The Act mandated that people have access to health insurance and that they would face a penalty if they weren’t on an insurance plan. To make this possible, the government introduced the Health Insurance Marketplace, Healthcare.gov, in 2014. People could then sign up for a health insurance plan that suited their needs through the Marketplace. 

However, the mandate and penalties on health insurance were later revoked and no longer apply in most states. 

Types Of Qualified Health Plans

Below are the different tiers of healthcare plans offered on the Marketplace:

  • Bronze Plans: These have the lowest premiums combined with higher cost-sharing. They cover about 60% of the average person’s healthcare expenses. 
  • Silver Plans: These provide about 70% coverage, and the premiums are slightly higher.
  • Gold Plans: These have higher premiums, covering about 80% of the average person’s healthcare needs.
  • Platinum Plans: These have the highest premium but cover 90% of your needs. They have the lowest deductibles and copayments.

Qualified Health Plans Vs. Other Health Insurance Options

The difference between QHPs and other health insurance options is that the law mandates what Qualified Health Plans cover. The plans need to cover certain needs to be considered a QHP and be eligible for government subsidy.

Other healthcare plans, like private or employer-provided plans, can remove benefits to reduce premiums. 

The Cost Of Qualified Health Plans

The average premium per month for a Qualified Health Plan is $450 for an individual and $1,157 for a family plan.

You may qualify for subsidies from the government based on your annual income. These subsidies can reduce your premium to as little as $10 per month.

The Enrollment Process For Qualified Health Plans

Your first step is determining whether you qualify for a Qualified Health Plan. If you do, you’ll need to register during the Open Enrollment Period or a Special Enrollment Period.

You can begin the enrollment process on the Health Insurance Marketplace website. Enter your name, social security number, income, and information about your household on the application form. This determines whether you’re eligible for subsidies.

Next, you can compare the available plans and select the one you want. Then, you can enroll in the plan by following the instructions provided on the website. 

However, this whole process can be time-consuming and it can be difficult to determine which plan is right for your needs. So, the best way to enroll for a Qualified Health Plan is to get in touch with our insurance advisors at Enhance Health

Our team works to support you by first understanding your needs, and then matching you with options that meet those needs. No more paying for benefits you don’t need, or signing up for plans that don’t cover your needs. 

We take you through the enrollment process from start to finish to help you choose the best plan, gather all the information you need, and activate your policy. 

Regulatory Requirements For Qualified Health Plans

As mentioned, QHPs need to cover essential benefits. These include preventive care, emergency services, hospitalization, prescription drugs, maternity care, and more.

QHPs also need to limit cost-sharing so that you aren’t required to pay an excessive amount for out-of-pocket costs and deductibles.

Accessing Care With Qualified Health Plans

You will need to select a Primary Care Physician as your primary point of contact for healthcare services. When you have any symptoms, illnesses, or concerns, you will contact them first.

If you need specialized care, your PCP will refer you to an in-network specialist. Your provider of choice may need to pre-authorize this. 


So there you have it, everything you need to know about Qualified Health Plans. For more information on which plan is the best option for you, visit Enhance Health. We give you access to plans that cost as little as $0 per month, making quality healthcare accessible for all!

Enhance Health-Representative
Get a Free Quote

Speak to a Licensed Agent

Affordable Healthcare
Get a Free Quote
Save big on health insurance