Qualified Health Plans (QHP)

What Are Qualified Health Plans?

A qualified health plan (QHP) is a type of health insurance plan that is certified by the Health Insurance Marketplace, covers the 10 essential health benefits including free preventive screenings, and limits cost-sharing such as deductibles, copayments and out-of-pocket expenses. 

Qualified Health Plan Terms 

Qualified Health Plan

A Marketplace or private health insurance plan that meets the requirements of the Affordable Care Act. 

Minimum Essential Coverage

The standard of coverage all qualified health plans are legally required to offer. They include the Obamacare 10 essential health benefits.


The division of costs between a policyholder and their insurance provider. With health insurance, cost-sharing is usually a combination of a deductible, co-insurance, copayments and out-of-pocket expenses. 

Mandatory Benefits for Qualified Health Plans

All qualified health plans are required to offer the 10 essential health benefits, which are known as "minimum essential coverage." These benefits are:

  • Ambulatory services
  • Emergency services
  • Hospitalizations
  • Prenatal and newborn care
  • Mental health services and substance abuse treatment
  • Prescription drug coverage
  • Rehabilitative services and related medical equipment
  • Lab services
  • Wellness and prevention services (like an annual physical)
  • Pediatric services that include dental and vision coverage

Qualified Health Plan vs. Other Health Plans

Qualified health plans provide policyholders with the greatest amount of healthcare security and coverage. They also meet the individual mandate requirements, sparing you from having to pay a tax penalty. If you buy a health insurance plan that is not a qualified health plan, you will still be fined for being uninsured by the IRS come tax season. 

Examples of qualified health insurance plans include any job-based plan, most student health plans, Medicare Part A or Part C, and coverage from the Children’s Health Insurance Program (CHIP). 

Costs of a Qualified Health Plan

The price of qualified health plans (QHP) varies. The Marketplace offers four types of QHP plans. Each category is known as a "metal tier," and they are Gold, Platinum, Silver and Bronze. Each tier has different levels of cost-sharing to cater to a vast market of people with different budgets and medical needs. 

If you want to learn more about the costs of a qualified health plan, whether it's through the Marketplace or a local provider, give one of our experienced agents a call 858-771-4087 or enter your zip code here!