Marketplace Health Insurance Guide for NRIs

Posted on: Nov 10, 2025 | 3 mins | Written by: HDFC ERGO Team

Marketplace Health Insurance Guide for NRIs

Moving from India to the US brings in many changes, and healthcare is one of the most significant among them. In India, a hospital visit or a basic health insurance plan is usually affordable. But once you move to the US, even routine medical care can become complicated and expensive without the right insurance coverage. For Non-Resident Indians (NRIs), the real challenge lies in the many rules, costs, and choices. This is where Marketplace Health Insurance helps; it offers a structured way to compare plans, understand benefits, and choose reliable coverage.

What is Marketplace Health Insurance?

The Marketplace health insurance, also known as the Health Insurance Marketplace or Exchange, was established under the Affordable Care Act in 2010. It is an online platform that enables individuals, families, and small businesses to compare and purchase health insurance plans. It is mandatory for all marketplace policies to cover essential benefits. They include emergency care, hospitalisation, prescription drugs, preventive services, and maternity care. This system is particularly valuable for NRIs as it ensures access to affordable, standardised, and legally compliant health insurance in the US.

How Marketplace Plans Work

Marketplace health insurance operates at both the federal and state levels. You will use the federal platform called HealthCare.gov in most states. However, states like California and New York run their own marketplaces with customised options.

Plans are organised into four tiers depending on how costs are shared between you and the insurer. They include Bronze, Silver, Gold, and Platinum. Bronze is the tier with the lowest premiums and also the highest out-of-pocket costs. On the other hand, Silver offers moderate premiums and added benefits for those who are eligible for cost-sharing reductions. Gold plans have higher premiums but lower service costs, making them suitable for families or people with ongoing medical needs. Platinum comes with the highest premiums but the lowest out-of-pocket expenses, making it ideal for frequent or specialised care.

Key Features and Benefits

Marketplace health insurance provides a range of essential features that ensure fairness, affordability, and protection for policyholders. They include:

1. Standardised coverage:

All marketplace plans cover essential health benefits. This ensures that the core areas of healthcare are always protected, regardless of which plan you choose.

2. Financial assistance and subsidies:

NRIs with moderate incomes may be eligible for tax credits and cost-sharing benefits. These subsidies can lower monthly premiums, deductibles, and out-of-pocket expenses.

3. Easy comparison:

Marketplace allows you to compare plans side by side. This makes it easier to evaluate premiums, deductibles, and provider networks.

4. Consumer protections:

Insurance companies cannot deny you coverage based on pre-existing conditions.

Eligibility and How to Enrol

You can buy marketplace insurance if you:

• Are a US citizen, national, or lawfully present immigrant. Green card holders and some visa categories are included.

• Live in the United States.

• Are not incarcerated.

Enrolment takes place during the Open Enrolment Period from November to December each year. If you miss it, you may qualify for a Special Enrolment Period after major life events such as marriage, childbirth, or loss of existing coverage. It is important to note these dates to prevent losing coverage.

Costs and Subsidies Explained

Marketplace health insurance also involves several costs, and they include expenses for:

• Premiums:

Fixed monthly payments to keep your plan active.

• Deductibles:

The amount you pay out of pocket before insurance covers services.

• Copayments and coinsurance:

The costs you pay after the deductible.

• Out-of-pocket maximums:

The yearly limit you will pay before the insurer covers 100%.

Subsidies are available to make coverage affordable. Premium tax credits lower monthly premiums, whereas cost-sharing reductions cut deductibles and copayments for eligible incomes. These benefits make mid-tier Silver plans far more affordable for many NRIs.

Pros and Cons of Marketplace Plans

Marketplace health insurance has its strengths and weaknesses, just like any system. Understanding these will help you decide if it is the right choice for you. Here are the pros and cons for consideration:

Pros

• Easy comparison of plans through a single platform

• Subsidies that lower premiums and out-of-pocket costs

• Standard coverage for essential health services

• Guaranteed acceptance for pre-existing conditions

Cons

• Premiums can be high without subsidies

• Limited doctor and hospital networks for some plans

• Confusion about using the system for first-time users

Tips to Choose the Right Plan

Choosing the right marketplace plan depends on your personal health needs and budget. Here are some points that can help you make a smarter decision:

• Assess your health needs:

A Bronze plan may be enough if you need little medical care. Families or those with ongoing conditions may prefer Gold or Platinum plans. This becomes even more important if you are also considering health insurance for senior citizens, as ageing parents often require more frequent care.

• Check provider networks:

Confirm that your preferred doctors and hospitals are covered, since out-of-network care can be costly.

• Consider out-of-pocket costs:

Look beyond premiums and compare deductibles, copayments, and maximum limits.

• Check for cultural fit:

Some providers offer services suited to immigrant communities, which may be more comfortable for NRIs.

Conclusion

Comparing premiums, deductibles, subsidies, and provider networks is the most effective way when you need to choose the right marketplace plan. Reviewing everything carefully will make sure that you don’t overpay. It will also ensure that essential services are covered when you need them. Selecting a family health insurance plan can offer full protection for all members of your family. At the same time, considering health insurance for senior citizens separately becomes essential if you have ageing parents who may need regular medical support.

FAQs

1. What is marketplace health insurance and who can apply?

It is a government-approved platform in the US where eligible residents, including NRIs with valid visas or green cards, can compare and buy health plans.

2. Can I include my dependents in a family health insurance plan?

Marketplace plans allow you to add your spouse and children. This makes it easier to cover the entire family under one policy.

3. Does health insurance for senior citizens cover pre-existing conditions?

Marketplace plans must cover pre-existing conditions, so older adults with ongoing health issues can still qualify for comprehensive coverage.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

Can I Reimburse Employees for Health Insurance?

What Are The Benefits For NRIs Buying Health Insurance ...

Can NRIs Buy Health Insurance in India?

Cheap Health Insurance Guide: Tips to Save Smart

Understanding Indemnity Health Insurance