Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Mar 19, 2020

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The lowdown...

  • The health insurance exchange program provides insurance that meets the individual mandate.
  • The federal marketplace is on the Web at www.healthcare.gov.
  • Sixteen states and the District of Columbia operate health insurance exchanges.
  • The exchanges are websites that provide access to approved health plans.


The Affordable Care Act brought some profound changes to the health care industry. The public had to learn a new language of metal plans and managed care organizations. The exchanges worked with the health service providers as they brought plans for sale to the public.

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The exchanges bridged the gap between the insurance providers and the public. The exchanges managed the financial and cost assistance programs that made qualified insurance more affordable and reachable for millions of newly insured subscribers.

What is the Exchange?

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The health insurance exchange is an online Web portal for qualified health insurance. It is a federal and state level organization that accepts proposed health insurance plans from private insurance companies for inclusion on the federal website at healthcare.gov and the affordable care website for each state.

Sixteen states and the District of Columbia operate state exchanges. They have used their powers to regulate the insurance industry to good advantage in the health industry. They have expertise in health care systems and the needs of their diverse communities.

Some jurisdictions have advanced innovative approaches to coordination of health resources. Others have passed unique laws such as New York which made pregnancy a qualifying event for a special enrollment period.

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Exchanges and the Federal Mandate

The individual mandate requires qualified insurance coverage or payment of the individual shared responsibility penalty. The federal and state exchanges sell qualified health plans. These plans satisfy the requirement of the individual mandate and avoid the penalty.

Qualified plans have the minimum value of insurance paid coverage. They also have the essential health benefits. Qualified health insurance contains prevention and wellness services. These valuable additions to every policy come at no extra costs to the subscriber. They include screenings, tests, examinations, laboratory work, x-rays, and vaccines.

Comparison shopping is an excellent tool for determining the value of a plan and rating offerings of the insurers. Comparison shopping helps consumers focus on the features of the plans that matter most to them.

Open Enrollment and Exceptions

The federal and state exchanges accept applications and assist subscribers during the critical high-demand open enrollment periods. Running from November through the following January, open enrollment is the designated time when every eligible person has a right to buy affordable health insurance.

The rule is that those that miss buying during open enrollment period must wait until the next open period. With the possible exception of Nevada, the rule applies to policies purchased off the exchange. The exceptions are for extensions of the open enrollment period and exceptions for special enrollments due to qualifying life events.

Obamacare Enrollment Dates by Year

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Open enrollment for Obamacare began with the calendar year 2014. Eligible residents must get coverage by the first day in January and keep it for 12 consecutive months. Some applications will not clear until the end of January 2017. Those applicants will begin coverage in February and will have waivers for the month of January. The below-listed items describe the open enrollment dates by calendar year.

  • Calendar year 2014 enrollment went from Oct 1, 2013, to March 31, 2014.
  • Calendar year 2015 enrollment ran from November 15, 2014, to February 15, 2015.
  • Calendar year 2016 enrollment ran from November 1, 2015, through January 31, 2016.
  • Calendar year 2017 enrollment runs from November 1, 2016, through January 31, 2017.

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Special Enrollment Periods

Those that fail to buy insurance during open enrollment period will have to pay a penalty for each month without insurance coverage. They can use an exception to get coverage. If they show a qualifying event, then they can get a sixty-day window to select health insurance.

Just as with the open enrollment, consumers can cancel a policy, switch to a new policy, or renew an existing policy. Comparisons shopping is a great way to assess the strengths of plans and options. The federal and state exchanges accept the below-listed items as qualifying events for a special enrollment period.

  • Divorce
  • Marriage
  • Adopting a child or taking in a foster child
  • Losing coverage as a dependent on parental policy at age 26
  • Losing coverage as dependent on a job-sponsored plan

Lowering the Costs of Health Insurance

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Consumers can only get premium subsidies, costs reduction assistance, and financial assistance from the federal and state exchanges. Tax credits provide premium assistance for qualified applicants. These subsidies dramatically reduce the amount that subscribers must pay on a monthly basis for coverage.

The exchanges are the only source of costs reduction assistance. Based on family income, the rules reduce the out-of-pocket expenses by decreasing the deductible threshold and the plan’s out-of-pocket expense limit.

State and Federal Review

The state and federal governments play a key role in helping insurance companies develop low-cost plans for the public. By passive or active interaction, the state and federal governments help insurers work to get high value and low price terms for consumers.

It is difficult to see the differences, but in the years before the Affordable Care Act, insurance rates could rise dramatically from year to year. Insurers had the right to turn away sick people and terminate agreements with those who used a lot of services.

The Affordable Care Act reformed the insurance industry; no longer could insurers deny coverage because of pre-existing conditions, and they could no longer discriminate against customers by charging higher rates for the same plan.

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Promoting Price Competition

The federal and state regulators look at the local competition and do what they can to promote price competition. One effective method is to get more than one provider for every market area of the country. Most plans have a particular geographic service area. It usually within a single state and county.

Limited Discrimination

The exchanges enforce the principles of the Affordable Care Act which forbids discrimination in pricing except for age, location, and tobacco usage. The exchanges work to ensure that plans treat subscribers equally. Tobacco cessation is an essential health benefit.

The law forbids discrimination against persons with mental health issues. It treats mental illness as it does physical illness and provides screening and counseling for early detection and treatment.

Corps Help Price

The ACA contained loan and price guarantees for consumer operated and oriented providers. This part of the law was partially repealed; it holds promise to help create a generation of low-cost high-volume service providers.

One must not underestimate the downward pressures these providers can exert on year to year pricing. In the health industry, the trend in pricing has advanced steadily upward at an alarming rate. The Affordable Care Act has slowed the rates of increase. Further innovations will help turn the trend downward including prevention, wellness, and incentives for improved hospital care.

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SHOP for Small Businesses

Small employers can cover employees and compete for tax credits and other incentives. The SHOP program operates through offices and exchanges at the state and federal level. There are 19 state level SHOP exchanges and all other state residents use the federal website.

Coordinating State Resources

The resources for health services include private facilities, community-based institutions, and local government agencies. States play a key role in running programs for children and the elderly. When applicants go to the exchange, they get advice and assistance on the wider range of healthcare resources. Exchanges help coordinate the below-listed resources.

  • Medicaid
  • Medicaid Expansion
  • Children’s Health Insurance Program
  • Medicare Parts A, B, C, and D.

The Health Insurance Exchanges

8 Ways To Protect Your Business With Health Insurance

The health insurance exchanges bring qualified health insurance plans to the American consumers. These plans have the minimum value and essential health benefits that satisfy the requirements of the individual mandate.

The exchanges work for small employers, small groups, families, and individuals. The federal government and the states that host exchanges work with insurance providers to bring high content and low prices into the marketplace.

Comparison shopping is a wonderful way to get to the best policy for an individual or family subscriber. It works well for small businesses and groups too. Comparison shopping can focus on the features that are most important to the users and find the best value.

Enter your zip code in our FREE tool below to start comparing health insurance rates now!