What Is Qualified Health Plan (QHP)?
The one-minute explanation of qualified health plan (qhp) — no jargon.
Qualified Health Plan (QHP): A plan certified to be sold on the Marketplace — it meets all ACA requirements, covers essential benefits, and is the only kind eligible for subsidies.
In Plain English
A Qualified Health Plan is a plan that passed certification: it covers the essential health benefits, follows guaranteed issue and community rating, meets cost-sharing limits, and is sold through the Marketplace. QHP is the only type of plan that can receive premium tax credits and cost-sharing reductions.
A Real Example
You're comparing two plans that look similar. One is a QHP on HealthCare.gov — eligible for your $400/month tax credit, covers pre-existing conditions, caps your out-of-pocket. The other is a cheaper off-marketplace plan that skips essential benefits and asks health questions. The QHP costs less out of your pocket and protects you more — once the credit applies.
Why It Matters When You Shop
"Qualified" is the dividing line between real ACA protection and everything else. If premium tax credits matter to you (and for most shoppers they do), you must buy a QHP through the Marketplace — buying the same insurer's non-QHP plan directly gets you zero subsidy.
Watch Out For
Some insurers sell similarly-named QHP and non-QHP versions. The non-QHP might be cheaper sticker-price but ineligible for credits. Always confirm you're looking at the Marketplace-certified version before comparing prices.
Related: Marketplace · Essential Health Benefits · Excepted Benefits
Common Questions
Can I buy a QHP outside the Marketplace? Yes — insurers sell QHPs directly too. But premium tax credits are only available through the Marketplace, so buying direct usually means leaving money on the table.
Are all Marketplace plans QHPs? Yes — everything sold on HealthCare.gov or a state exchange is certified. The non-QHP versions live off-exchange.
Do QHPs cover dental for adults? No — adult dental isn't an essential benefit. Pediatric dental is. Adults buy standalone dental separately.
Put It to Work
Make "Is this a Qualified Health Plan?" your standard question for any health coverage offer — especially from telemarketers, social media ads, and workplace "alternatives." A yes means ACA protections and subsidy eligibility; a no means you need to understand exactly what you're buying. Legitimate sellers answer instantly; evasive ones have told you everything you need to know.
How I Explain It to Clients
"QHP is the stamp that says 'real insurance,'" I tell people fielding sketchy offers. "If someone's selling you health coverage and can't say yes to 'is this a Qualified Health Plan,' you're not buying health insurance — you're buying something else wearing its clothes." It's the fastest due-diligence question in the business, and it takes four seconds.
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