Glossary
Qualified Health Plan (QHP)
An insurance plan certified by the Marketplace as meeting ACA standards — it covers all 10 essential health benefits, caps out-of-pocket costs, prohibits preexisting-condition exclusions, and qualifies for federal subsidies.
Last updated: May 18, 2026
A Qualified Health Plan (QHP) is the official name for an insurance plan that has been certified by a federal or state Marketplace as meeting the standards of the Affordable Care Act. If you buy through HealthCare.gov or a state Marketplace (Covered California, NY State of Health, etc.), every plan on offer is a QHP. If you buy off-Marketplace directly from an insurer, the plan may or may not be a QHP.
Only QHPs are eligible for the APTC and CSR federal subsidies.
What every QHP must cover
The ACA requires every QHP to cover the 10 essential health benefits:
- Ambulatory patient services (outpatient care)
- Emergency services
- Hospitalization
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services
- Laboratory services
- Preventive and wellness services (and chronic disease management)
- Pediatric services, including oral and vision care for children
Plans also must:
- Cover preexisting conditions with no waiting period
- Limit your out-of-pocket maximum to a federal cap (about $9,200 individual / $18,400 family for 2026)
- Allow children to stay on a parent’s plan until age 26
- Offer free preventive care (annual physicals, vaccines, screenings) with no cost-sharing
- Comply with metal tier actuarial values (Bronze ~60%, Silver ~70%, Gold ~80%, Platinum ~90%)
QHP vs other types of coverage
| Plan type | QHP? | Subsidies? |
|---|---|---|
| Marketplace plan (HealthCare.gov, state exchange) | Yes | Yes |
| Off-Marketplace ACA-compliant plan | Yes (certified by issuer) | No |
| Short-term limited-duration insurance | No | No |
| Health-care sharing ministries | No | No |
| Limited-benefit / “indemnity” plans | No | No |
| Medicaid / CHIP | Separate category | N/A |
| Medicare | Separate category | N/A |
If a plan is not a QHP, it likely will not cover the 10 essential health benefits and likely does not protect you against catastrophic costs. Avoid mistaking a “discount card” or “short-term plan” for an ACA plan.
How to verify a plan is a QHP
The Marketplace shows a green “ACA Marketplace” badge on every plan. Off-Marketplace, ask the insurer in writing: “Is this a Qualified Health Plan that meets all ACA requirements?” Get it in writing.
Why QHP status matters for immigrants
For most lawfully present immigrants, only QHPs are subsidized. If an agent steers you toward a non-QHP “alternative” plan and tells you the subsidies do not apply because you are an immigrant, that is incorrect — they apply to lawfully present immigrants buying QHPs through the Marketplace. Get a second opinion.
Related terms
Compare QHPs, a licensed agent walks you through the plans available in your county.