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Qualified health plan (QHP)

A qualified health plan is an insurance plan that meets your state's standards for covering basic health needs. Every health plan on your state's Marketplace has to be a qualified health plan. These are some requirements a QHP must meet:

  • Covers essential health benefits such as doctors’ visits and emergency care
  • Limits how much you have to spend on deductibles, copays, and other out-of-pocket health care expenses
  • Includes a reasonable number of providers in its network, which is decided by your state
  • Meets other requirements of the Affordable Care Act.

If you do not enroll in a qualified health plan, you will have to pay a tax penalty for going without qualified health insurance. “Grandfathered” health plans are not required to comply with all of these standards. These are policies that were  in existence before the Affordable Care Act was passed in 2010 and have not made significant changes to costs and benefits.

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