State exchanges vs. the federal marketplace: Where should I shop for health insurance?

Need health insurance? Fortunately for you, you can soon be on the road to getting a plan, thanks to the Affordable Care Act (ACA). The ACA has helped make health insurance available to tens of millions of Americans, including the 35 million people who enrolled through online marketplaces in 2022.

Among other important features, the ACA established an online marketplace, or exchange, where you can shop for an insurance plan on your own during open enrollment and special enrollment periods. Or you can simply do it through companies like HealthMarkets.

How you shop for your health plan and which plans are available to you depends on where you live. Here’s what you need to know.

Why shop for health insurance on an exchange?

If you don’t have health insurance coverage through your employer, you’ll have to shop for a plan on your own. You have several options:

• Companies like HealthMarkets have licensed insurance agents whom you can call to help you compare, contrast, and buy insurance plans. You can also compare, shop for, and enroll in plans online.
• The government also has a website (aka the federal marketplace) where you can buy insurance.
• Your state may also have an exchange, which serves the same purpose as the federal marketplace.

Who’s selling these plans? Private insurance companies, who must meet certain criteria and follow rules set by the government, sell them. The plans can’t deny you coverage or charge you more if you have a preexisting condition, such as diabetes or cancer. And they must cover certain kinds of care and preventive services.

All three shopping options can help get the job done, but an easy option is to simply go to HealthMarkets.com or call a licensed insurance agent at 1-800-827-9990. You can also start your search by browsing available plans online.

Whether you buy your health plan through HealthMarkets or another option, you’ll find that plans are categorized by metal levels: bronze, silver, gold and platinum. They vary based on their monthly premium costs and how much the insurance company pays for care. For example, bronze plans have the lowest monthly bills (premiums), but you’ll pay more out of pocket for care.

Whether you shop on HealthMarkets, the federal marketplace or a state exchange, you may have access to tax credits and subsidies that may lower your premium costs. Those subsidies are a key feature of the ACA. While shopping, you’ll be asked about your household size and income. Based on that information, you’ll find out whether you qualify for a tax credit and how much it will be.

State exchanges vs. the federal marketplace

The federal marketplace and state exchanges both offer you ways to buy health insurance. But it all depends on where you live. Under the ACA, the federal government provides funding for states to set up their own exchanges, which a number of them do. But many states have opted out.

This can cause a lot of confusion. If you don’t want to bother figuring out which website to go to, you can try another option: purchasing coverage on a third-party website like HealthMarkets. They allow you to buy health insurance coverage from federal or state exchanges all in one place. Call a licensed insurance agent at 1-800-827-9990, or shop for plans online.

ACA enrollment tips for everyone

Whether you’re shopping for insurance on the federal marketplace, a state exchange or a third-party site like HealthMarkets, which allows you to enroll in both, follow these simple guidelines to make it easier on yourself:

1. Be aware of the deadlines. Open Enrollment Period (OEP) normally runs from November 1 through January 15 for the federal marketplace. But be sure to sign up by December 15 if you want your coverage to take effect on January 1. Some state-run marketplaces have slightly different enrollment windows, with some opening a bit earlier or staying open a bit later. Anytime during OEP or your state’s enrollment window, you can also call a licensed insurance agent at 1-800-827-9990 or visit this page to buy a plan.

2. Gather up your family’s data. Dig up everybody’s Social Security number and last year’s tax returns. You’ll also want to guesstimate your income for next year. Also, be sure to think about what your health needs might be for the upcoming year. Ask yourself: Will that include doctor visits, hospital stays or prescription drugs?

3. Browse the plans. You can compare premiums and learn about each plan’s copays and provider networks. You can even check to see which plans cover your providers and prescription medicines. You can also get all this information by calling a licensed insurance agent at 1-800-827-9990.

4. Learn about financial assistance. Many people are eligible for discounts on their insurance. For example, are you eligible for a premium tax credit? It all depends on what your income is the year you’re applying. A licensed agent can help you calculate that total and figure out whether you might be eligible (call one at 1-800-827-9990). Note: The amount of assistance you receive may vary from state to state.

5. Ask for help. It’s easy to get confused when there are so many plan options and websites to buy them on available. On average, people had about 83 plans to choose from in 2022. If your head is spinning from all the possibilities, help is available ? and it comes at no cost to you. Call a licensed insurance agent at 1-800-827-9990, or compare plans online to get started.