Health Insurance Exchanges Explained
Find Cheap Health Insurance in Your Area
An Affordable Care Act (ACA) health insurance exchange is a website that lets you shop for health insurance in your area.
Exchanges are also called health insurance marketplaces. The federal health insurance exchange is called HealthCare.gov, and several states use their own specific state marketplaces.
What is a health insurance exchange?
A health insurance exchange or marketplace is a website where you buy Affordable Care Act (ACA) plans. Individuals, families and small businesses can all buy plans on a health insurance marketplace. These plans are often called "Affordable Care Act plans" or "Obamacare plans."
You don't need to use a marketplace site if you have health insurance through your job, or if you qualify for Medicare. But some marketplace websites can check eligibility for Medicaid and have tools to help you enroll.
On an exchange, you can see the plans available in your area, compare plans, fill out an application, buy a plan and qualify for discounts. But a health insurance exchange isn't the same as your insurance company. Once you buy a plan on an exchange, you'll view and manage your health insurance with the specific health insurance company you chose.
HealthCare.gov and state exchanges
The biggest health insurance exchange is HealthCare.gov, the federal health insurance marketplace. In most states, this is the website you use to shop for and buy health insurance.
However, 18 states and the District of Columbia don't use HealthCare.gov. If you enter your ZIP code for one of these states on HealthCare.gov, the website will direct you to a state-run marketplace.
State | Health insurance exchange |
|---|---|
| California health insurance exchange | Covered California |
| Colorado health insurance exchange | Connect for Health Colorado |
| Connecticut health insurance exchange | Access Health CT |
| Idaho health insurance exchange | Your Health Idaho |
| Kentucky health insurance exchange | Kynect |
Whether you buy a plan through the insurance exchange in your state or on HealthCare.gov, it’s considered "on-exchange" health insurance and it follows the Affordable Care Act guidelines.
What types of plans can I buy on the exchange?
Exchanges sell health insurance for individuals, families and small businesses.
Because all the plans on an exchange follow Affordable Care Act guidelines, they are called qualified health plans (QHPs). All the plans cover at least 10 common health situations like visits to the doctor, emergency care and prescription medications.
Plans sold on health insurance exchanges come in different levels of coverage, called plan tiers.
Plan tier | Average monthly cost |
|---|---|
| Catastrophic | $335 |
| Bronze | $462 |
| Silver | $584 |
| Gold | $641 |
| Platinum | $813 |
Average monthly rates are for a 40-year-old single person. Expanded Bronze plans have been omitted due to a lack of data across states.
Catastrophic plans pay the lowest share of your medical bills, while Platinum plans pay the highest share. Depending on where you live, you might be able to choose between all of these plan tiers, or you may only have a few options. An Expanded Bronze option is available in some states, but it's not a common option.
Most marketplace sites can also check your eligibility for Medicaid and help you enroll, although some states use separate websites for this. But you won't be able to check if you are eligible for Medicare or sign up on a health insurance exchange. For that, you'll need to go to Medicare.gov.
When can I enroll in coverage through an exchange?
In most states, you can sign up for health insurance on an exchange website between Nov. 1 and Jan. 15.
This is called open enrollment. In some states, the dates are slightly different. In California, for example, you can sign up through Jan. 31. And in Idaho, open enrollment is Oct. 15 through Dec. 15.
You might be able to enroll in a plan at another time if you move, have a baby, get married or lose your job. These, and other, life events let you sign up for a health insurance plan any time during the year. This is called a special enrollment period.
How to enroll on a health insurance exchange
Whether you use HealthCare.gov or a state exchange, enrolling for a plan is fairly straightforward. You'll shop for a plan, make your choice and fill out an application all from the health insurance exchange.
First, you'll enter information about yourself, including your ZIP code. You may also be asked about your income and family size. You don't have to enter this information, but it helps you get more accurate quotes and checks your eligibility for discounts. You also can put in your doctors and your prescriptions to see how various plans cover them.
Next, you'll see a list of the plans in your area. Depending on the site, you can filter the list by insurance company, plan type, cost and other key factors. To help narrow your choices even further, you can select multiple plans for a side-by-side comparison.
After you've reviewed your options and chosen a plan, you can fill out an online application. You'll need your personal information and information about anyone else you want the plan to cover, like a spouse or children.
Finally, watch your mail or online account for updates and to see if there are any issues with your application. To complete your enrollment and start your coverage, you have to make the first monthly payment to the insurance company you picked. You'll also receive a packet with plan details and your identification cards in the mail or virtually.
It usually makes sense to enroll in a health insurance plan through a state or federal health insurance exchange, rather than directly with an insurance company. When you enroll through an exchange, you can access cost-cutting programs that might save you money.
Why should I buy insurance on the exchange?
If you don't get health insurance through your job, an exchange is the best way to compare plans from multiple companies and get health insurance discounts.
Health insurance exchanges show you all the plans in your area, which makes it easier to compare rates, coverage and plan perks. And while you could shop for a plan through a broker or agent, you won't be able to get extra savings that are available on exchanges.
If you buy insurance on an exchange, you might qualify for discounts based on your income. You can only get these discounts, called subsidies if you buy a plan from HealthCare.gov or your state exchange. You can't get subsidies if you buy a plan directly from an insurance company.
Individuals and families making less than four times the federal poverty level are eligible for subsidies that give you a cheaper rate. Based on 2023 federal poverty level income levels, single people have to earn less than $58,320 per year, and a family of four must earn under $120,000 per year. For example, if you are single and you earned $30,000 in 2023, you could pay around $50 per month for a Silver health insurance plan with a subsidy.
If you earned more than four times the federal poverty level last year, you might still qualify for a rate reduction. That's because the Inflation Reduction Act caps the maximum price of a health insurance plan at 8.5% of your household income. The 8.5% cap on health insurance costs is set to expire after 2025.
If you made less than two and a half times the federal poverty level in 2023, you are eligible for another kind of savings. If you choose a Silver plan, you won't have to pay as much when you go to the doctor. That's because your income qualifies you to get lower deductibles, copays and coinsurance. This discount is called a cost-sharing reduction.
Frequently asked questions
What is a health insurance marketplace?
A health insurance marketplace or exchange is a website where you can review the health insurance plans in your area and buy one. HealthCare.gov is the federal health insurance marketplace. It's also the biggest, used by 32 states. The other 18 states and Washington, D.C. use their own state-run health insurance exchanges.
Is the marketplace the same as Obamacare?
The plans that you buy on a marketplace are all "Obamacare" plans. These plans comply with the rules of the Affordable Care Act, which is often called "Obamacare." But the Affordable Care Act was much more than just the health insurance plans on exchanges. It also set out standards that health insurance companies had to follow and expanded access to Medicaid in most states.
What does "off-exchange" health insurance mean?
Off-exchange health insurance is a private health insurance plan that you don't buy on the federal or state marketplace. For example, if you buy a plan through a insurance broker, an agent or directly from an insurance company's website, that's an off-exchange plan. You can't get rate discounts or cost-sharing reductions if you buy a plan off-exchange. Off-exchange plans don't refer to Medicare, Medicaid or health insurance from your job.
Sources
ValuePenguin sources health insurance rates from public use files (PUFs) on the Centers for Medicare & Medicaid Services (CMS) government website and state marketplace sites. Plans and providers for which county-level data was included in the CMS Crosswalk file were used in our analysis; those excluded from this data set may not appear.
Other sources for this article include HealthCare.gov and state marketplace sites.
Editorial note: The content of this article is based on the author’s opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners.