Health Insurance Exchanges/Marketplaces

Exchanges at a Glance  Exchange FAQs 

The Affordable Care Act (ACA) created guidelines for a new kind of marketplace for health insurance. Learn more about exchanges and how Aetna supports them.

Exchanges/Marketplaces at a Glance

What are exchanges?
Exchanges (also called "marketplaces") are online markets where consumers and small businesses can go to shop for health insurance. On these sites, they can compare the available plans and then purchase online. In many cases, consumers shopping on a public exchange may be eligible for subsidies to help make health insurance more affordable.

Learn more about exchanges/marketplaces
Want to learn more? Our short, easy-to-understand videos can help.

Understand the basics about exchanges:

Thinking about shopping for a 2015 plan on the exchange? Find out what's changing this open enrollment for public exchanges:

Public Exchange/Marketplace Frequently Asked Questions (FAQs)

Who creates and maintains the exchanges?

  • Each state has the option to create and operate its own exchange.
  • If the state decided not to create its own exchange, the federal government administers the exchange in that state.
  • Outside of the government, private exchanges may also exist.

Who can shop on a public exchange?
Individuals and small employers* can shop for health insurance on the public exchanges during open enrollment periods. Outside of open enrollment, consumers can shop for a plan if they have a life-changing event (such as having a baby or losing their coverage).

Do exchanges help address the cost of health insurance?
For individuals who meet certain criteria, two new elements can help make health insurance affordable for them:

What kinds of plans are available on an exchange?
To participate on an exchange, health plans need to meet specific criteria. Here are the basics:

Where can I go to learn more about my state’s exchange?

To find out what your state has, visit Healthcare.gov. You will find links to the state-specific exchange websites.

I’ve never had insurance; how do I know what plan I should pick?

Your state exchange/marketplace has people, called Navigators, who are there to help walk you through the shopping process. They can help you compare plans and ask questions to help you find the right fit for you. Or, you can work with your broker, if you have one, to find out more about plans available to you.

I bought a plan on the exchange last year. Can I enroll in the same plan for next year?

In most cases you can automatically renew your current plan for 2015. Your carrier will send you a letter letting you know if you can renew your plan, or if you need to select a new plan.

Even if you can renew the plan you have today, you always have the option to shop for a different plan once the exchanges open for enrollment on November 15, 2014.

When can I enroll in a plan on the exchange?

For the 2015 plan year, open enrollment will begin on November 15, 2014 and end on February 15, 2015.

If you have had a life-changing event, you may qualify for enrollment outside of the open enrollment period. To learn more about what qualifies as a life-changing event, please visit https://www.healthcare.gov/ for more information.

What do your plans on exchange cover?

All of our Aetna and Coventry plans comply with the new ACA requirements for 2014. Any benefits package sold on or off of an exchange to individuals and small group employees must include coverage for what are called “essential health benefits .”

To learn more about Aetna’s exchange plans, visit http://www.aetna.com/individuals-families/health-insurance-exchange.html or www.coventryone.com


What do the metallic levels on an exchange mean?

To help make shopping easier, health plans on a public exchange are labeled platinum, gold, silver or bronze. The metallic level helps shoppers understand the level of coverage a plan offers – how much they will need to pay and what the plan pays.

Platinum plans typically mean that you will pay less for medical services, but your monthly premium will be higher. With a bronze plan, on the other hand, you will typically pay more for medical services, but your monthly premium will be lower.

See health plan categories to learn more.

Am I eligible for financial aid on an exchange?

The ACA provides premium tax credits and subsidies for individuals who qualify, to help make insurance more affordable, when they shop on a public exchange.

You can determine if you are eligible when you shop on the exchange. The exchange will ask you for information about your income level and then let you know what financial assistance you may qualify for.

How do I know if my doctor participates in a plan sold on an exchange?

You can link to an online provider directory while you are shopping on the exchange, to see which providers are in each carrier’s network and plan.

I have insurance through my employer. Can I still shop for a plan on an exchange?

Yes. However, if your employer is offering you coverage, you may not qualify for financial assistance. The exchange can help you understand if you qualify.

For definitions of these and other exchange-related terms, visit our exchange glossary page.

How do I know if I don’t qualify for financial assistance on the exchange because of the insurance my employer offers?

You may have received a letter from your employer that lets you know that public exchanges were available as of October 1, 2013, and whether the coverage your employer offers meets certain standards set by the ACA. If their coverage does meet those standards, then you are probably not eligible for financial assistance on the public exchange. However, you can contact the exchange in your state to learn more.

Additional resources:

 * Online enrollment for SHOP has been delated until 2015.