Obamacare Health Insurance Exchanges

What the Obamacare Health Exchanges Are, and How You Can Use Them

health exchanges accessed with a laptop
The exchanges allow you to shop online for a health care plan that meets your needs. Photo: Photo: Cultura/Getty Images

The health care exchanges, also known as the Marketplace, open for enrollment each year in November. These exchanges are a result of the Patient Protection and Affordable Care Act of 2010, which created what is known as Obamacare. Twelve million Americans used the exchanges to buy insurance and 88% of them received a subsidy in 2021.

You can always use the exchanges to compare plans. You can also find out if you are eligible for a tax subsidy or Medicaid.

Health Insurance Exchange Explained

The healthcare exchanges are marketplaces where you can choose the type of insurance that best meets your needs. They are either run by the state or the federal Department of Health and Human Services. Your state legislature made that decision.

The exchanges provide an easy-to-follow series of questions to help you determine what the best plan is for you. They also define insurance terms, so you know exactly what you're getting. They do ask some surprisingly personal questions at the beginning. But that's just to get you verified. It's not much different than when you fill out information for a loan.

The exchanges offer plans in four different categories: Bronze, Silver, Gold, and Platinum. Bronze has the lowest premiums, but you'll pay the highest out-of-pocket costs when you access care. Platinum is the opposite. It has the highest premiums, but the lowest costs when you access care.

These categories allow you to compare similar types of plans with different copays, deductibles, and annual payment limits from various companies. Since insurance can be complicated, be aware of how you choose an insurance plan.

The biggest benefit of the exchanges is that they help you find health care discounts and benefits. For example, you may be eligible for expanded Medicaid if you live in one of the states that took this benefit.

Depending on where you live, the number of people in your household, and your household income, you may qualify for a premium tax credit to help cover your monthly insurance payments. You may also be eligible for reduced copayments or deductibles, known as "cost-sharing reductions" or "extra savings" (only for Silver plans). Note the specific income requirements are determined by comparing your income to the federal poverty level for each year.

Essential Health Benefits

Most of the insurance plans offered by the exchanges must cover the following 10 essential health benefits:

  • Emergency room services.
  • Hospitalization.
  • Outpatient care.
  • Preventive and wellness visits, as well as chronic disease management. Preventive care visits have no copay when you see a provider in your plan's network.
  • Lab tests.
  • Pregnancy, maternity, and newborn care before and after birth.
  • Pediatric care.
  • Mental and behavioral health treatment.
  • Prescription drugs.
  • Services and devices to help people with injuries, disabilities, or chronic conditions.

What You Should Do Now

You can compare plans on the exchanges, and use the Get Answers section to see answers to frequently asked questions.

If you already have insurance, you may want to get a better plan through the exchange. For example, if your plan existed on or before March 23, 2010, it was "grandfathered in." That means it doesn't have to provide all of the essential benefits. You might want to change it for a new plan on the exchange. Find out more about grandfathered health plans. If you like the plan you have, you can keep it.

Small-Business Owners

Small-business owners may qualify for tax credits. If you have a small business with 50 or more workers, you have to provide insurance or face a penalty. You don't have to provide insurance if you have fewer than 50 employees. Here's where to get familiar with the Small Business Health Options Program Marketplace.

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  1. Health Affairs. "Marketplace Enrollment Tops 12 Million for 2021; Largest-Ever Funding for Navigators."

  2. HealthCare.gov. "The 'Metal' Categories: Bronze, Silver, Gold & Platinum."

  3. HealthCare.gov. "Premium Tax Credit."

  4. HealthCare.gov. "Cost Sharing Reduction (CSR)."

  5. HealthCare.gov. "What Marketplace Health Insurance Plans Cover."

  6. HealthCare.gov. "Grandfathered Health Insurance Plans."

  7. HealthCare.gov. "How the Affordable Care Act Affects Small Businesses."

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