A health insurance exchange – also known as a health insurance marketplace – is a key provision of the Affordable Care Act, established to provide a selection of competing providers, each offering different qualified plans. All qualified plans must meet standards set by the ACA.
The idea was that the exchange would provide one-stop shopping for consumers, and that competition among insurers would encourage them to improve the quality and pricing of offered plans. That has happened in some parts of the country, but there are a significant number of counties across the country where only one insurer is offering exchange coverage for 2018.
For practical purposes, the exchange is an online portal where consumers can shop for health insurance. For people who qualify for premium subsidies or cost-sharing subsidies, the exchange is the only place that the subsidies can be obtained (each state has an exchange; most of them use HealthCare.gov, but there are 12 states that operate their own exchange platforms).
Enrollees who are eligible for Medicaid or CHIP (Children’s Health Insurance Program) can enroll in those plans via the exchanges. And pediatric dental coverage is also available through the exchange, either embedded in the medical plans, or as stand-alone coverage.
Open enrollment in the exchanges starts on November 1 each year, and ends on December 15, with all plans effective January 1 of the coming year (for 2018 coverage, nine state-run exchanges have extended the enrollment deadline).