How Do State Health Insurance Exchanges Work? 
A health insurance exchange is a government-run marketplace where people can buy health insurance plans . One of the big questions everyone asks is whats the difference between buying a health plan on the exchange and off the exchange ? The key difference is the subsidies . You can only get a subsidy if youre buying your coverage on an exchange they can not be used towards plans purchased off the exchange . An advantage of buying a plan off the exchange is you will generally have more choices available for you to choose from . The same plan that is offered on the exchange and off the exchange may have some differences as well . Plans that are on the exchange may have more regulations , therefore requiring they feature additional benefits directly through the plan as opposed to needing a separate stand alone policy to provide the supplemental benefit -LRB- e.g. vision care , dental care , etc. -RRB- off the exchange plans may not be subject to the same standards . Off the exchange plans must still meet the requirements of the Affordable Care Act -LRB- including offering the 10 essential health benefits -RRB- . Its important to remember than not every plan that is offered off the exchanges will be available on the exchanges . Carriers reserve the right not to offer coverage on the exchanges . Thus , some states may have numerous plan selections for consumers where others may have limited choices . Also , not every type of health insurance plan is available on the exchanges short term policies and large group policies are not offered on exchanges at this time . There 's a lot of moving parts to health insurance and given the issues that have occurred with the new healthcare system rollout , it 's highly recommended you work with an experienced health insurance broker to make sure everything is in good order for your program . I hope the information is helpful - please feel free to contact me for help or if you have any other questions . Thanks very much . 