The Affordable Care Act (ACA) requires every state to have a health insurance exchange or marketplace. These exchanges allow individuals and small businesses to purchase their own health insurance coverage or get financial assistance through Medicaid or premium tax credits.
While some states use the federal exchange, others established their own state-run health insurance exchanges. This means that depending on where you live, you’ll need to know which exchange to use to find coverage.
This guide to the individual health insurance marketplaces explains what the exchanges are, how they differ, and which states have their own marketplaces.
What are the state and federal health insurance marketplaces?
The health insurance marketplaces are where individuals and families can shop for health insurance plans and receive access to premium tax credits. They can also purchase dental plans. Each state has an exchange residents must use if they want to enroll in marketplace coverage. These are either state-run marketplaces, state-federal partnerships, or the federal government’s Health Insurance Marketplace.
You aren’t required to purchase health insurance coverage through the marketplaces. Some employers offer group health insurance coverage to their employees. Individuals and families can also purchase a plan from the individual market through a private exchange or work with an insurance broker.
The health insurance exchanges allow you to get a qualified health plan that covers the ACA’s essential health benefits. Many people believe marketplace coverage is only for those with low incomes. However, anyone can find a plan that fits their needs. This misconception might stem from the federal subsidies available on the exchanges, such as premium tax credits. These subsidies lower your premiums and the government bases eligibility on the federal poverty level.
Now millions of Americans can get access to affordable health insurance coverage.
When can you enroll in marketplace coverage?
You can enroll in marketplace plans during open enrollment. This runs from November 1 through January 15 in states that use HealthCare.gov. States with their own exchanges can choose different open enrollment periods. All Americans must enroll in marketplace coverage by December 15 if they want their coverage to start on January 1.
How does a state-based marketplace differ from the federal Health Insurance Marketplace?
A state-based exchange is where a state government regulates the exchange. The state controls plan eligibility, enrollment, customer support, enrollment assistance, premium tax credit eligibility, and marketing efforts. States also deal directly with health insurance carriers to determine which plans they list on the marketplace.
The federal government runs HealthCare.gov and controls these functions in places without a state-run marketplace. This eases the burden on many states that don’t have the capacity or funding to run a state-based exchange.
There are also state and federal partnerships. Some states manage their own exchanges but use the federal Health Insurance Marketplace for enrollment.
Health insurance marketplaces by state
As of 2023, 18 states and D.C. have state-based marketplaces, two have a state-based marketplace that uses the federal platform, and 30 states use the federal Marketplace.
|Individual health insurance marketplace1
|My Arkansas Health Insurance Marketplace (uses HealthCare.gov for enrollment)
|Connect for Health Colorado
|Access Health CT
|District of Columbia
|DC Health Link
|Your Health Idaho
|Maryland Health Connection
|Massachusetts Health Connector
|Nevada Health Link
|Get Covered NJ
|New York State of Health
|Oregon Health Insurance Marketplace (uses HealthCare.gov for enrollment)
|Vermont Health Connect
|Virginia's Insurance Marketplace (new for 2024 open enrollment)
* CMS approved Georgia's plan to launch a state-based exchange in 2024 for 2025 open enrollment.
** Hawaii previously ran a state-based marketplace called Hawaii Health Connector.
What health insurance plans are available on the marketplaces?
The plans available for individuals and families depend on your state. Some states will have more carriers and options than others. But, every exchange has plans that fit the different ACA metallic tiers of health coverage.
These plans range from bronze to platinum and cover different amounts of your healthcare costs. Catastrophic health plans are also available for those under 30. Bronze plans have lower monthly premiums but higher deductibles than other metal levels. In contrast, platinum plans have the highest monthly premiums and lowest deductibles.
The types of health insurance available2 on the marketplaces include the following:
- Exclusive provider organization (EPO)
- Health maintenance organization (HMO)
- Point of service (POS)
- Preferred provider organization (PPO)
How individual health insurance benefits employers
If you’re an employer, you may wonder how individual health insurance benefits your organization. Traditional group health insurance is expensive and complex. These plans often come with minimum participation requirements and annual rate increases that small businesses and nonprofits struggle to meet.
Instead, employers can provide a health reimbursement arrangement (HRA) to their employees. This allows employers to reimburse their employees tax-free for their qualifying medical expenses and, depending on the HRA, individual health insurance premiums. This allows employees to choose the health plan that best fits their unique needs while saving organizations time and money.
The two types of HRAs that can reimburse individual health insurance premiums are:
- The qualified small employer HRA (QSEHRA): A QSEHRA is specifically for organizations with fewer than 50 full-time equivalent employees (FTEs).
- The individual coverage HRA (ICHRA): An excellent health benefit for organizations of all sizes. Applicable large employers (ALEs) that offer an affordable allowance can use an ICHRA to satisfy the employer mandate.
When you offer an HRA, your employees will use their state or federal marketplace (or an insurance broker) to enroll in individual coverage. You’ll offer a monthly allowance to reimburse your employees for their eligible expenses, and your employees then request reimbursement for their expenses.
By administering your HRA through PeopleKeep’s employee benefits software solutions, you can save time on ensuring proper compliance. We’ll review your employees’ expenses for you and help you through every step of the process.
The state and federal health insurance marketplaces provide millions of Americans with access to affordable healthcare coverage. Depending on where you live, you’ll either use a state-run exchange or the federal exchange. No matter which one you must use in your state, the ACA guarantees standard levels of coverage.
By understanding which exchange your state uses you’ll be better prepared for open enrollment.
Chase Charaba is the content marketing manager at PeopleKeep. He started with the company as a content marketing specialist in early 2022. Chase has written more than 350 blog posts for various companies and personal projects throughout his career. He’s worked for digital marketing agencies, in-house marketing teams, and as the editor for national award-winning high school and college newspapers. He’s also a YouTuber, landscape photographer, and small business owner.
Sheria ya Affordable Care Act (ACA) inahitaji kila jimbo kuwa na soko la bima ya afya. Mabadiliko haya huruhusu watu binafsi na biashara ndogo kununua bima yao ya afya au kupata msaada wa kifedha kupitia Medicaid au mikopo ya kodi ya malipo. Wakati baadhi ya majimbo kutumia kubadilishana shirikisho, wengine kuanzisha yao wenyewe serikali ya bima ya afya kubadilishana. Hii ina maana kwamba kulingana na ambapo unaishi, unahitaji kujua ambayo kubadilishana kutumia kupata chanjo. Mwongozo huu wa soko la bima ya afya ya mtu binafsi unaelezea nini kubadilishana ni, jinsi wanavyotofautiana, na ni majimbo gani yana soko lao wenyewe. Ni nini soko la bima ya afya ya serikali na ya shirikisho? Soko la bima ya afya ni mahali ambapo watu binafsi na familia wanaweza kununua mipango ya bima ya afya na kupata upatikanaji wa mikopo ya kodi ya malipo. Pia wanaweza kununua mipango ya matibabu ya meno. Kila jimbo lina wakazi wa kubadilishana lazima kutumia kama wanataka kujiandikisha katika chanjo soko. Hizi ni ama soko linaloendeshwa na serikali, ushirikiano wa serikali na shirikisho, au soko la bima ya afya la serikali ya shirikisho. Wewe si required kununua bima ya afya chanjo kupitia soko. Waajiri fulani hutoa bima ya afya ya kikundi kwa wafanyakazi wao. Watu binafsi na familia pia wanaweza kununua mpango kutoka soko la mtu binafsi kupitia kubadilishana binafsi au kazi na broker bima. Mabadiliko ya bima ya afya hukuruhusu kupata mpango wa afya unaostahili ambao unashughulikia faida muhimu za afya za ACA. Watu wengi huamini kwamba huduma za soko ni kwa ajili ya wale wenye mapato ya chini tu. Hata hivyo, mtu yeyote aweza kupata mpango unaolingana na mahitaji yake. Dhana hii mbaya inaweza kutokea kutokana na ruzuku ya shirikisho inapatikana kwenye kubadilishana, kama vile mkopo wa kodi premium. Misaada hii hupunguza malipo yako na serikali hutegemea haki yako kwenye kiwango cha umaskini cha shirikisho. Sasa mamilioni ya Wamarekani wanaweza kupata upatikanaji wa bima ya afya ya bei nafuu. Ni lini unaweza kujiandikisha katika chanjo ya soko? Unaweza kujiandikisha katika mipango ya soko wakati wa uandikishaji wazi. Hii itaanza Novemba 1 hadi Januari 15 katika majimbo ambayo hutumia HealthCare.gov. Majimbo na kubadilishana yao wenyewe wanaweza kuchagua vipindi tofauti wazi uandikishaji. Wamarekani wote wanapaswa kujiandikisha katika chanjo ya soko kabla ya Desemba 15 ikiwa wanataka chanjo yao kuanza Januari 1. Soko la bima ya afya la serikali inatofautianaje na soko la bima ya afya la shirikisho? Kubadilishana kwa msingi wa jimbo ni ambapo serikali ya jimbo inasimamia kubadilishana. Serikali inasimamia uhalali wa mpango, uandikishaji, msaada wa wateja, msaada wa uandikishaji, uhalali wa mkopo wa kodi ya premium, na juhudi za uuzaji. Majimbo pia kushughulika moja kwa moja na waendeshaji wa bima ya afya kuamua ambayo mipango wao orodha juu ya soko. Serikali ya shirikisho inaendesha HealthCare.gov na kudhibiti kazi hizi katika maeneo bila soko linaloendeshwa na serikali. Hii hupunguza mzigo juu ya majimbo mengi ambayo hawana uwezo au fedha za kuendesha kubadilishana msingi wa jimbo. Pia kuna ushirikiano wa serikali na shirikisho. Baadhi ya majimbo kusimamia kubadilishana yao wenyewe lakini kutumia shirikisho la Afya Bima Marketplace kwa ajili ya uandikishaji. Kwa mfano, katika nchi za Ulaya, nchi za 18 na DC zina soko la serikali, mbili zina soko la serikali ambalo hutumia jukwaa la shirikisho, na majimbo 30 hutumia soko la shirikisho. "Mashirika ya afya ya Marekani, pamoja na kampuni ya afya ya Marekani, ""Contact for Health"" ya Colorado, ""Access Health"" ya Maryland, ""Health Connect"" ya Massachusetts, ""Health Connect"" ya Nevada, ""Health Connect"" ya New York, ""Health Connect"" ya Vermont, na ""Health Connect"" ya Virginia, ""Health Connect"" ya New Jersey, na ""Health Connect"" ya New Jersey, ni pamoja na kampuni ya afya ya New Jersey." Hawaii ina soko la afya la hali ya juu linaloitwa Hawaii Health Connector. Ni mipango gani ya bima ya afya inayopatikana sokoni? Mipango inayopatikana kwa watu binafsi na familia inategemea jimbo lako. Baadhi ya majimbo yatakuwa na waendeshaji zaidi na chaguzi kuliko wengine. Lakini, kila kubadilishana ina mipango ambayo inafaa ngazi tofauti za chuma za ACA za chanjo ya afya. Mipango hii huanzia shaba hadi platinamu na inashughulikia kiasi tofauti cha gharama zako za huduma za afya. Mipango ya afya ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari ya hatari. Mipango ya shaba ina malipo ya chini ya kila mwezi lakini deductibles ya juu kuliko viwango vingine vya chuma. Kinyume chake, mipango ya platinamu ina malipo ya juu zaidi ya kila mwezi na mapato ya chini zaidi. Aina za bima ya afya zinazopatikana kwenye soko ni pamoja na zifuatazo: Shirika la Mtoaji wa Kipekee (EPO), Shirika la Uhifadhi wa Afya (HMO), Kituo cha Huduma (POS), Shirika la Mtoaji wa Mapendeleo (PPO), Jinsi ya Bima ya Afya ya Mtu binafsi inanufaisha Waajiri. Bima ya afya ya kikundi ya kitamaduni ni ghali na ngumu. Mipango hii mara nyingi huja na mahitaji ya chini ya ushiriki na ongezeko la kiwango cha kila mwaka kwamba biashara ndogo na mashirika yasiyo ya faida hujitahidi kukidhi. Kwa mfano, kwa mfano, wafanyikazi wanaweza kutoa mpango wa malipo ya afya (HRA) kwa wafanyikazi wao. Hii inaruhusu waajiri kulipia wafanyakazi wao bila kodi kwa ajili ya gharama zao za matibabu ya kufuzu na, kulingana na HRA, malipo ya bima ya afya ya mtu binafsi. Hii inaruhusu wafanyakazi kuchagua mpango wa afya ambayo inafaa zaidi mahitaji yao ya kipekee wakati kuokoa mashirika wakati na fedha. HRAs ni aina mbili za HRAs ambazo zinaweza kulipia malipo ya malipo ya bima ya afya ya mtu binafsi: HRA ya Mwajiri Mdogo wa Kiasi (QSEHRA) ni maalum kwa mashirika yenye wafanyikazi wa muda kamili wa chini ya 50. - Ulinzi wa mtu binafsi HRA (ICHRA): Faida bora ya afya kwa mashirika ya ukubwa wote. Waajiri wakubwa wanaotumika (ALE) ambao hutoa ruzuku ya bei nafuu wanaweza kutumia ICHRA ili kukidhi amri ya mwajiri. Wakati wa kutoa HRA, wafanyikazi wako watatumia soko lao la serikali au shirikisho (au broker ya bima) kujiandikisha katika chanjo ya mtu binafsi. Utatoa ruzuku ya kila mwezi ili kulipia wafanyakazi wako kwa ajili ya gharama zao zinazostahili, na wafanyakazi wako kisha kuomba malipo ya gharama zao. Kwa kusimamia HRA yako kupitia suluhisho la programu ya faida ya mfanyakazi wa PeopleKeep, unaweza kuokoa wakati wa kuhakikisha kufuata sahihi. Sisi <unk>ll kupitia wafanyakazi wako <unk> gharama kwa ajili yenu na kukusaidia kupitia kila hatua ya mchakato. Soko la bima ya afya la serikali na shirikisho hutoa mamilioni ya Wamarekani upatikanaji wa chanjo ya afya ya bei nafuu. Kulingana na mahali unapoishi, utaweza kutumia kubadilishana kwa serikali au kubadilishana kwa shirikisho. Haijalishi ni ipi ya kutumia katika hali yako, ACA inahakikisha viwango vya kawaida vya chanjo. Kwa kuelewa ambayo kubadilishana hali yako inatumia utakuwa vizuri tayari kwa ajili ya kujiandikisha wazi. Chase Charaba ni meneja wa uuzaji wa maudhui katika PeopleKeep. Alianza kazi yake katika kampuni hiyo kama mtaalamu wa uuzaji wa yaliyomo mwanzoni mwa 2022. Chase ameandika zaidi ya machapisho ya blogi 350 kwa kampuni mbalimbali na miradi ya kibinafsi katika kazi yake. Amefanya kazi kwa mashirika ya uuzaji wa dijiti, timu za uuzaji wa ndani, na kama mhariri wa magazeti ya kitaifa ya shule ya sekondari na chuo kikuu. Yeye pia ni YouTuber, mpiga picha wa mandhari, na mmiliki wa biashara ndogo ndogo.