health insurance exchange

What is a health insurance exchange?

A health insurance exchange, also known as a Marketplace, is a platform where consumers can compare and buy individual health insurance plans offered by various private health insurance companies, and also access income-based financial assistance.

Each state has a health insurance exchange, established under the Affordable Care Act (ACA). State health insurance exchanges allow individuals — and in some states, small businesses — to compare numerous health insurance plans side-by-side, and purchase the coverage that best fits their needs.

All individual and small-group plans with effective dates of 2014 or later must cover the ACA's essential health benefits, cannot use medical underwriting, and must cover pre-existing conditions. These requirements apply both on and off the exchange. But consumers are only eligible to receive premium subsidies and cost-sharing reductions if they purchase their coverage through the exchange (note that this can include enrolling directly through the exchange, or enrolling in an exchange plan via an enhanced direct enrollment entity).

How many people are enrolled in coverage through the health insurance exchanges?

Nationwide, there were more than 22 million people enrolled in private plans through the exchanges as of mid-2025.¹ And the Treasury Department reported that nearly 50 million Americans had been enrolled in coverage through the exchanges at some point between 2014 and 2024.²

When can I enroll in coverage through the exchange?

You can only enroll in coverage through the exchange (or off-exchange) during the annual open enrollment period or a special enrollment period. Open enrollment begins November 1. Starting in the fall of 2026 (for coverage effective in 2027), it will end on December 15 in most states. But state-run Marketplaces will have the option to extend open enrollment until as late as December 31.

What is the name of my state's health insurance exchange?

As of the 2026 plan year, 30 states use HealthCare.gov as their exchange portal; the remaining 20 states and DC have their own state-run exchanges and enrollment systems. Two of the states that use HealthCare.gov for 2026 are considered state-based exchanges, but use the federal platform for enrollment (Arkansas and Oregon). Regardless of where you live, you can start at HealthCare.gov. If your state runs its own enrollment platform, HealthCare.gov will direct you to the correct website.