health insurance marketplace

What is a health insurance marketplace?

health insurance marketplace – or health insurance exchange – is a place (both online and in-person) where consumers can purchase private individual/family health insurance and receive subsidies to make coverage and care more affordable. As of early 2020, there were about 10.7 million Americans enrolled in marketplace plans throughout the country.

The health insurance marketplace concept is a key provision of the Affordable Care Act, allowing consumers to select from among a variety of private health insurance companies that offer different qualified health plans (in some areas of the country, only one insurer offers plans for sale in the marketplace, but there will still be a variety of plans available).

All qualified plans must be ACA-compliant – meeting standards established and enforced by the federal government. So when a person shops in the health insurance marketplace, they can be sure that the participating insurers will not use medical underwriting or exclude pre-existing conditions. All of the available plans will cover the ACA’s essential health benefits without annual or lifetime benefit caps.

Premium subsidies and cost-sharing reductions are only available through the health insurance marketplace.

Each state has just one official health insurance marketplace, operated either by the state, the federal government, or both. In most states, HealthCare.gov serves as the marketplace. But some states run their own platforms, such as Covered California, New York State of Health, Connect for Health Colorado, MNsure, etc.

There is an open enrollment period each fall when people can enroll in coverage through the marketplace (the same open enrollment window also applies to plans that are available outside the marketplace, purchased directly from the insurance companies). In most states, the open enrollment period is November 1 to December 15, although some of the state-run exchanges have extended enrollment windows.

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