Qualified Health Plan (QHP)
An ACA-compliant health insurance plan certified for sale on a federal or state health insurance marketplace.
What is Qualified Health Plan?
A qualified health plan (QHP) is a health insurance policy that meets specific standards set by the Affordable Care Act, is certified by a health insurance marketplace (either the federal HealthCare.gov or a state-based exchange), and is sold by a state-licensed insurer. QHPs must cover the ACA's ten essential health benefits — including preventive care, emergency services, prescription drugs, mental health services, maternity care, and pediatric services — and must comply with rules on cost-sharing limits, pre-existing condition coverage, and plan metal tiers (Bronze, Silver, Gold, Platinum). Only QHPs sold through the marketplace make enrollees eligible for premium tax credits and cost-sharing reductions. Plans sold outside the marketplace that meet ACA standards are ACA-compliant but not QHPs. Short-term health plans and certain grandfathered plans are not QHPs.
Example
A self-employed individual shops on HealthCare.gov during open enrollment. All plans listed are QHPs certified for the federal marketplace. She selects a Gold-tier QHP, making her eligible for a premium tax credit that reduces her monthly premium by $210. If she purchased an equivalent plan directly from the insurer outside the marketplace, it might be ACA-compliant but she would lose access to the tax credit.