QHP

Qualified Health Plan (QHP) is a health insurance plan that meets the standards of the Affordable Care Act and is offered for sale on a state-based or federally facilitated Health Insurance Marketplace. QHPs are certified by the appropriate regulatory authorities and are designed to provide standardized coverage with consumer protections and the potential for premium subsidies.

Key features include coverage of essential health benefits, adherence to actuarial value categories (bronze, silver, gold, platinum) that reflect expected cost-sharing, and, for eligible individuals, the possibility of cost-sharing reductions. All QHPs must include an annual out-of-pocket limit for essential benefits and provide preventive services at no cost to the enrollee. Plans must present benefits in a standardized Summary of Benefits and Coverage to facilitate comparisons and maintain adequate provider networks.

QHPs are offered through the Health Insurance Marketplace; consumers can enroll during open enrollment or special enrollment periods. Eligibility for premium tax credits and cost-sharing subsidies depends on income and other qualifying factors.

Not all plans sold in the individual or small-group market are QHPs—only those that meet Marketplace standards are designated as QHPs. Catastrophic plans are a subset of QHPs available to some individuals under specific conditions, though not all Marketplace plans qualify as catastrophic.