Which of the following is available ONLY if the consumer purchases coverage in the health insurance exchange?

• A. Immediate coverage for pre-existing condition limitations
• B. Coverage for essential health benefits
• C. No annual or lifetime limits for essential health benefits
• D. Access to premium tax credits and reduced cost sharing

Answer: (D)

Subsidies that lower your monthly premium and out-of-pocket costs are provided through the Health Insurance Marketplace, and only when you enroll there. Premium tax credits reduce the monthly premium, and cost-sharing reductions lower deductibles and other out-of-pocket costs for eligible, typically lower-income individuals. These subsidies are tied to buying a plan through the Marketplace and meeting income requirements, so they aren’t available if you purchase coverage off the Marketplace.

Other protections—like coverage of essential health benefits, no annual or lifetime dollar limits for those benefits, and protections against pre-existing condition exclusions—exist for ACA‑compliant plans regardless of whether you buy through the Marketplace or directly from a insurer. That’s why the subsidy-related option is the one that’s exclusive to Marketplace coverage.