An insurance exchange – or health insurance marketplace – is a key Obamacare provision created to provide consumers with a one-stop shopping experience and access to a selection of competing health insurance companies, each offering different qualified health plans. These plans must meet standards set by the Affordable Care Act. Competition between plans encourages insurers to improve the quality and pricing of offered plans.
Through the exchange – either federally or state-operated – consumers can shop online for health insurance and determine whether they qualify for premium subsidies or cost-sharing subsidies. Although ACA-compliant plans are available outside the exchange in nearly every state, the subsidies are only available for plans purchased via the exchanges.
In 2020, there are 13 state-run exchanges that have their own enrollment platforms, and 38 states that use HealthCare.gov. But some of those 38 states have state-run exchanges and simply use HealthCare.gov as the enrollment platform. And some of the states that use the federally-run exchange have retained state oversight of the plans and/or operate as a partnership with the federal government.
New Jersey and Pennsylvania will join the states that have their own enrollment platforms as of the fall of 2020, bringing the total number of fully state-run exchanges to 15. Here’s an overview of what approach each state takes with regards to the exchange. In any case, there is only one official exchange in each state.