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Health Insurance Marketplaces 101

Health insurance Marketplaces (you may hear them called Exchanges) are state-based online marketplaces where people and small businesses can shop for and buy private health insurance. The Marketplace is a destination where consumers can easily compare insurance options based on price, benefits, quality and other factors to help them choose the insurance that best fits their needs. You can visit www.Healthcare.gov to access your state’s Marketplace. Below is information that can help you use the Marketplace to purchase health insurance.


Healthcare Coverage Enrollment FAQs

Who can enroll through a Marketplace?
  • Use the Marketplace if you do not have coverage through your job, Medicare, Medicaid or the Children’s Health Insurance Program (CHIP). 
  • If you get insurance from your employer, you can buy through the Marketplace, but you’ll likely pay full price unless your insurance isn’t affordable or doesn’t meet certain standards.  
  • You must live in the U.S. as a citizen or be here legally.
  • You may not be in prison. Once you are granted parole, you will have the opportunity to purchase health coverage on the exchange or enroll in Medicaid. 
Why should I enroll through the Marketplace?
  • You'll get coverage for pre-existing health conditions that may have kept you from getting coverage in the past. 
  • You can compare costs and coverage between different health insurance plans. 
  • You can see your premium, deductibles and out-of-pocket costs before you decide to enroll. 
  • Most people who enroll through the Marketplace receive some level of financial support (87% last year). 
  • Insurance companies and brokers who sell plans outside of the Marketplace may not show you all of your options and may receive extra money to sell you certain plans, regardless of whether they are appropriate for you. 
What can I buy through the Marketplace?
  • There are four categories of plans – Bronze, Silver, Gold and Platinum. They balance coverage and out-of-pocket costs. This video provides a brief explanation about the trade-offs between different plans and this website provides additional information to help you shop.
  • In general, the more you pay in premiums, the less you will pay in deductibles and other costs.
  • Marketplace catastrophic plans have low premiums and very high deductibles. They cover the same essential health benefits as other Marketplace plans, but you cannot receive financial support for them, and they are only available to people under 30 or with a hardship exemption.
What will a Marketplace health plan cover?

All health plans offered on the Marketplace must cover a comprehensive set of benefits, including physician visits, preventive care, hospital stays and prescriptions. Plans must also treat everyone fairly; discrimination based on pre-existing conditions is prohibited.

When can I enroll?
  • Anyone can enroll through the Marketplace during open enrollment. In 2021, open enrollment runs from November 1 to December 15. California, Colorado, DC, Massachusetts, Minnesota, Nevada, New Jersey, New York, Pennsylvania and Rhode Island have extended the deadline for open enrollment beyond December 15. Check with your state marketplace to learn more.
  • You might qualify to enroll outside of open enrollment because of a “qualifying life event” that allows you to access a Special Enrollment Period. Find out if you are eligible here.
I’m already enrolled in the Marketplace. Is there anything I should do?
  • A lot has changed this year, so you should double check if your plan is still the best fit for you.  Your plan may have changed their doctors and hospitals as well as the medications that are covered.  
  • Costs may be very different compared to last year.  You should check if you have better options to maximize your access to financial support.
  • If you are satisfied that your current plan is still the best choice, you can allow your plan to automatically renew.
Who can help me with the process?
  • Information is available on the website www.HealthCare.gov where you can also find resources, videos, and checklists and live web chat available 24/7 in English and Spanish.  
  • Consumers can call (1-800-318-2596) 24 hours a day, 7 days a week and reach customer service representatives that are trained to help you complete your application. 
  • The call center is available in English and Spanish and has a language line to assist callers in over 150 additional languages.
  • There is also web-support for non-English speakers. Para español, visite www.CuidadoDeSalud.gov. You can also select other languages and find help on this site.
Are there people in my area who can help me?
  • For local help, you can work with a Navigator, a Certified Application Counselor (sometimes called an assister) or an Insurance Broker.  
  • Navigators and Application Counselors are trained to provide impartial education about the Marketplace, help applicants determine whether they qualify for subsidies or Medicaid, and assist them in the enrollment process. They cannot recommend one plan over another, and your choice does not impact how they are paid.  
    • Input your zip code into this independent site for help finding a local Application Counselor.
  • Insurance Brokers are insurance professionals who are certified by the Marketplaces to provide enrollment assistance. Unlike Navigators and Application Counselors, they can recommend a plan. Their services are generally free to the consumers. Some, but not all, brokers receive a commission from the health plans for whom they sell products. 
  • You should only access an Insurance Broker through your Marketplace – to ensure they are licensed and trained. This link allows you to request help from a Marketplace-registered Broker. 
  • If you are using a Broker, here are a few questions to consider asking:
    • Do you represent all plans on the Marketplace? Ideally, a broker should represent all plans in your area, so you know they are looking at all your options.
    • How are you compensated? If brokers make more commission from one plan than another, it might inappropriately influence their recommendation.  
    • Why are you recommending this plan for my family?
How do I pick a health plan?

The Marketplace lets you compare based on your priorities.  You should consider the trade-off between monthly premiums and the costs you will have to pay from your own pocket when you receive care.  Also look to see if the doctors and places you go to get care are included in the plans you are considering. Finally, it is important to check to see if your medications are covered and how much you will have to pay for them. For additional help, see our checklists for lung disease patients and tobacco users.

What if I’m worried about being able to afford insurance?
  • This calculator can help you determine if you may be eligible for financial help. Last year, 87 percent of people who bought on the Marketplace qualified for help. 
  • Help may come in two forms.  You may be eligible for: 
    • A premium subsidy to help offset the cost of your monthly premiums. The premium subsidy can be used with any of the Platinum-Gold-Silver-Bronze plans.
    • Cost sharing reductions (CSR) lower the amount you pay when you receive care. All people eligible for CSR support are also eligible for premium subsidies but not vice versa. Unlike the premium subsidies, CSRs can only be used with a qualified Silver plan.
  • Subsidies do not apply to catastrophic plans or any plan not purchased through the Marketplace.
  • Your state Marketplace will check your income to confirm your eligibility.
Do I still have to buy insurance?

As of January 1, 2019, there is no federal financial penalty if you do not purchase health insurance.

What is the current status of health insurance Marketplaces?
  • Congress failed to repeal and replace the Affordable Care Act, so Marketplaces are still the best place to shop for insurance.
  • Marketplaces are stabilizing. Some states have set rates for 2021 that are only slightly higher than 2020 and other states are reporting rate decreases. 
  • There are more consumer choices for 2021. Every U.S. county has at least one insurer selling insurance through the Marketplace. Some insurers who previously exited the Marketplace have recently returned.
I’ve heard there are ways to get less expensive insurance. Does the Marketplace sell those?
  • You have the option to purchase a “short-term limited-duration” plan. They are less expensive because they have significant limitations. They can charge higher premiums based on health status, exclude coverage for preexisting conditions, and place caps on how much they will cover.  
  • By federal rules, short-term plans are allowed for up to 12 months and may be renewed for a maximum period of 36 months. Some states have shorter maximum periods, like six months.
  • Before buying a short-term plan, check out our fact sheet about the risks.

Page last updated: October 14, 2020

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