The number of private exchanges – established by benefit companies and health insurance carriers – has grown in recent years. However, the exchanges you’re hearing about are most likely the state health insurance exchanges that were established as part of the Affordable Care Act (ACA) – that’s what’s described here.
State health insurance exchanges are a platform that allows individuals and small businesses to compare numerous health insurance plans side-by-side, and purchase the coverage that best fits their needs.
Under the ACA, all individual and small-group plans must conform to the same regulations, regardless of whether they’re sold through the exchange or off-exchange. All individual and small-group plans effective January 2014 or later must cover ten essential health benefits including emergency services, hospitalization, preventive services and more; 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.
Open enrollment periods are the same on or off the exchange, and you can’t switch from having an off-exchange plan to having an on-exchange plan outside of open enrollment, unless you have a qualifying event.
As of 2020, there are 38 states that use HealthCare.gov as their exchange portal; the remaining 12 states and DC have their own state-run exchanges and enrollment systems. Five of the states that use HealthCare.gov are considered state-based exchanges, but use the federal platform for enrollment (Arkansas, Kentucky, New Jersey, Pennsylvania, Oregon, and New Mexico).
Pennsylvania and New Jersey, both of which use HealthCare.gov in 2020, plan to operate their own state-run health insurance exchanges starting in the fall of 2020. So residents in those states will enroll in 2021 coverage using the state-run platforms.
State health insurance marketplaces – or exchanges – vary in terms of enrollment platforms, carrier availability, rates and more.
There are 18 fully state-run health insurance marketplaces, three state-based marketplaces using the federal platform, six state-federal partnership marketplaces, and 24 fully federally run marketplaces.
If you're self-employed, a broker can help you enroll through the exchange, giving you personalized help and recommendations, but also allowing you to get any Obamacare subsidies for which you're eligible.
Here's where you should look for help if have trouble enrolling through a health insurance marketplace – or if you have issues with your individual-market ACA-compliant health plan.
Sweeping health reform legislation delivered a long list of provisions focused on health insurance affordability, consumer protections.