health insurance exchange

What is a health insurance exchange?

A health insurance exchange, also known as a Marketplace, is a platform where consumers can compare and buy individual health insurance plans offered by various private health insurance companies, and also access income-based financial assistance.

Each state has a health insurance exchange, established under the Affordable Care Act (ACA). State health insurance exchanges allow individuals — and in some states, small businesses — to compare numerous health insurance plans side-by-side, and purchase the coverage that best fits their needs.

All individual and small-group plans with effective dates of 2014 or later must cover the ACA’s essential health benefits, cannot use medical underwriting, and must cover pre-existing conditions. These requirements apply both on and off the exchange. But consumers are only eligible to receive premium subsidies and cost-sharing reductions if they purchase their coverage through the exchange.

How many people are enrolled in coverage through the health insurance exchanges?

Nationwide, there were almost 21 million people enrolled in private plans through the exchanges as of early 2024.¹ And the Treasury Department reported that nearly 50 million Americans had been enrolled in coverage through the exchanges at some point between 2014 and 2024.²

When can I enroll in coverage through the exchange?

You can only enroll in coverage through the exchange (or off-exchange) during the annual open enrollment period or a special enrollment period. In most states, open enrollment runs from November 1 to January 15. Most special enrollment periods are triggered by qualifying life events. But some circumstances will grant a person a special enrollment period without a specific qualifying event.

What is the name of my state's health insurance exchange?

As of the 2025 plan year, 31 states use HealthCare.gov as their exchange portal; the remaining 19 states and DC have their own state-run exchanges and enrollment systems. Three of the states that use HealthCare.gov for 2025 are considered state-based exchanges, but use the federal platform for enrollment (Arkansas, Illinois, and Oregon). Regardless of where you live, you can start at HealthCare.gov. If your state runs its own enrollment platform, HealthCare.gov will direct you to the correct website.

Georgia used HealthCare.gov from 2014 through 2024, but has created a fully state-run enrollment platform that debuts in the fall of 2024, for coverage effective in 2025. Illinois will join them in the fall of 2025,³ and Oregon in the fall of 2026.⁴