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Frequently asked questions
What are Obamacare health insurance plans?
Obamacare plans are eligible for reduced costs through a subsidy tax credit. They're offered only through the federal marketplace (healthcare.gov) or a state's own exchange — but certified brokers, agents, and web brokers can help you enroll and apply for a subsidy.
What are Off-Exchange health insurance plans?
Off-Exchange plans are available outside the federal marketplaces and existed before Obamacare — for example, individual-market plans for people without job-based coverage. You can enroll through a broker, agent, web broker, or directly with the insurance company.
What's the difference between Obamacare and Off-Exchange plans?
The main difference is that only Obamacare plans are eligible for a subsidy tax credit. Otherwise, plan design, coverage, and rates are similar, and both must follow federal regulations. Many plans are sold as both Obamacare and Off-Exchange.
Can a plan be both an Obamacare and Off-Exchange plan?
Yes. A plan can be available as both. Some plans are offered only as Obamacare plans, while others are offered only as Off-Exchange plans.
Do plans that are both cost the same price?
Yes — by law, a plan offered as both must be sold at the same price, and brokers and agents must sell at the same market price. Keep in mind only the Obamacare version is eligible for a subsidy to reduce the monthly premium.
Who is eligible for Obamacare and Off-Exchange plans?
Technically everyone is eligible for both. The real question is who qualifies for a subsidy tax credit, which can only reduce the cost of Obamacare plans. Even without a subsidy, you can still buy an Obamacare plan at full price.
What is the Obamacare subsidy (tax credit)?
The subsidy is a tax credit formally known as the Advanced Premium Tax Credit (APTC). It can be taken "in advance" during the year to lower your monthly premium instead of waiting until you file taxes.
You must complete an official federal application to learn your amount — everyone's is different and based mainly on household income. We recommend using our tool to estimate it.
Who is eligible to receive an Obamacare subsidy?
To qualify to reduce monthly premiums, you generally must:
- Meet income requirements based on household size (e.g. under ~$48,240 for an individual or ~$98,400 for a family of four)
- Not be eligible for other government coverage like Medicare or Medicaid
- Not have access to qualifying, affordable job-based coverage
- File taxes (married couples must file jointly)
- Not be incarcerated
- Be legally present in the United States
Why should I consider Off-Exchange plans?
Off-Exchange plans can give you more options — especially if you aren't eligible for a subsidy, or only a small one. Your preferred doctor may only accept an Off-Exchange plan, so we recommend checking provider networks (we link to official doctor lookups). Some carriers have left the Obamacare market but still offer Off-Exchange plans.
How do I choose the plan that's best for me and my family?
Understand a few key concepts first — premium price, out-of-pocket costs, deductibles, and metal levels. Our choosing-a-plan FAQ explains each one.