The Marketplace, explained agent to agent.

The four metal tiers

Every ACA Marketplace plan is one of four tiers (plus Catastrophic for a narrow group). The tier doesn't describe quality of care — it describes the split between premium and out-of-pocket cost.

Premium Tax Credits — and the subsidy cliff is back

The enhanced Premium Tax Credit (the ARPA/IRA "enhanced PTC") expired January 1, 2026. The original ACA subsidy structure did not disappear — it just reverted to its pre-2021 rules. That reversion is the thing to actually understand.

Cost-Sharing Reductions (CSR)

CSRs lower deductibles, copays, and coinsurance — not the premium. They were not affected by the enhanced-PTC expiration; they're a separate provision with their own eligibility rule.

When clients can enroll or make changes

Unlike Medicare, the ACA Marketplace has one national Open Enrollment window plus event-triggered Special Enrollment Periods — no MA-style annual switch window.

2026 costs at a glance

Averages nationally — actual numbers vary heavily by state, carrier, and age. Always confirm the specific plan's numbers before quoting.

Compliance basics for the ACA side

The Medicare TPMO framework doesn't apply here — the ACA Marketplace runs on its own CMS registration, training, and consent rules. Don't assume Medicare compliance habits automatically cover you.

Glossary: ACA terms every agent should know cold

The shorthand you'll hear on every ACA call and training — defined once, in plain language.

PTC Premium Tax Credit

The base ACA subsidy that lowers a household's monthly premium, available between 100–400% of FPL. Calculated against the benchmark Silver plan.

Enhanced PTC ARPA/IRA subsidy boost

The temporary expansion that removed the 400% FPL income cap and increased subsidy amounts. Expired January 1, 2026.

CSR Cost-Sharing Reduction

Lowers deductibles and copays (not premium) for 100–250% FPL households enrolled in a Silver plan specifically.

FPL Federal Poverty Level

The income benchmark used to determine PTC and CSR eligibility. Updated annually; subsidy eligibility is expressed as a percentage of it.

MAGI Modified Adjusted Gross Income

The income figure actually used to calculate subsidy eligibility — not gross income or take-home pay.

Benchmark Plan 2nd-lowest-cost Silver

The second-lowest-cost Silver plan in a given area — the reference point the PTC amount is calculated against, regardless of which plan the client actually picks.

Subsidy Cliff 400% FPL cutoff

The point above which a household receives no PTC at all. Eliminated by the enhanced PTC 2021–2025; back in effect for 2026.

QHP Qualified Health Plan

Any plan certified to be sold on the ACA Marketplace, meeting Essential Health Benefits and other ACA requirements.

Metal Tier Bronze/Silver/Gold/Platinum

Categorizes plans by actuarial value (the average share of costs the plan covers) — not by network quality.

Actuarial Value AV

The average percentage of total costs a plan is designed to cover for a standard population — 60% Bronze up to 90% Platinum.

OEP Open Enrollment Period

Nov 1 – Jan 15 in most states — the one guaranteed annual window to enroll or change plans for any reason.

SEP Special Enrollment Period

A window opened by a qualifying life event — loss of coverage, marriage, birth, a move, or a subsidy-affecting income change. Typically 60 days.

EDE Enhanced Direct Enrollment

CMS-approved third-party platforms (not Healthcare.gov itself) that agents can use to quote and enroll clients, with their own added consent/audit rules.

CR 109 EDE authorization requirement

The CMS change requiring agent/broker authorization — and, for high-risk cases, consumer identity proofing first — before an agent can proceed on an EDE platform. Enforced by the platform itself, separate from and in addition to consumer consent. Required no later than Oct 12, 2026.

Navigator Not the same as an agent

Grant-funded, uncommissioned, plan-neutral assister. Distinct from a commissioned agent/broker — never blur this distinction with a client.

SBM State-Based Marketplace

A state-run exchange (instead of Healthcare.gov) with its own enrollment dates, rules, and sometimes its own subsidy add-ons.

Silver Loading Rate-setting strategy

A pricing practice where carriers price CSR costs entirely into Silver-tier premiums, which can make Gold plans unusually cheap relative to Silver for subsidized enrollees — worth checking every area, not assuming.

1095-A Marketplace tax form

The form the Marketplace issues showing months of coverage and subsidy received — needed to reconcile actual vs. estimated PTC on the client's tax return (Form 8962).

Form 8962 PTC reconciliation

The IRS form reconciling advance PTC paid during the year against the PTC the household actually qualified for based on final income — can result in owing money back or getting more credit.

MLMS Marketplace Learning Mgmt System

CMS's training and registration platform agents must complete annually to assist consumers with Marketplace coverage.

Essential Health Benefits EHB

The 10 categories of coverage every ACA-compliant plan must include — from emergency care to maternity to prescription drugs.

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Official ACA Marketplace resources

Verify anything here directly — subsidy rules and enrollment dates are actively changing for 2026.

Internal ACA agent tools

Where the actual sales process and application walkthrough live — not external resources, your own working tools.