Under the Affordable Care Act (ACA), each state has the option to run its own health insurance marketplace, or to use the federally facilitated one through HealthCare.gov. As of 2025, some states operate fully state-run marketplaces with their own websites, deadlines, and plan offerings—while others rely on the federal government’s platform.

State-Based Marketplaces vs. Federally Facilitated Marketplaces

When the ACA was passed in 2010, it gave states the opportunity to build and manage their own health insurance exchanges. If a state declined, the federal government would step in and provide ACA-compliant plans through HealthCare.gov.

Today:

• 20 states (plus Washington, D.C.) run their own marketplaces

• 3 states use the federal platform for enrollment, but manage their own backend operations

• The remaining 28 states use the federally facilitated marketplace

State-based marketplaces allow local governments more control over how plans are regulated, priced, and promoted. They can also set their own Open Enrollment Period (OEP) dates, which is helpful for residents who need more time to enroll.

States That Operate Their Own Health Insurance Exchanges (2025)

Here are the states that currently operate their own health insurance marketplaces, along with their platform names:

• California – Covered California

• Colorado – Connect for Health Colorado

• Connecticut – Access Health CT

• District of Columbia (D.C.) – DC Health Link

• Idaho – Your Health Idaho

• Maryland – Maryland Health Connection

• Massachusetts – Massachusetts Health Connector

• Minnesota – MNsure

• Nevada – Nevada Health Link

• New Jersey – Get Covered NJ

• New York – NY State of Health

• Pennsylvania – Pennie

• Rhode Island – HealthSource RI

• Vermont – Vermont Health Connect

• Washington – Washington Healthplanfinder

Each of these states may offer unique plan choices, local insurer options, and extended enrollment deadlines beyond the federal window.

When Is Open Enrollment for ACA Plans in 2025?

The federal Open Enrollment Period for 2025 coverage is expected to run from November 1, 2024 through January 15, 2025. However, some state-run marketplaces set their own deadlines and may offer enrollment extensions.

What If You Miss Open Enrollment?

If you don’t enroll during the Open Enrollment Period and don’t qualify for a Special Enrollment Period (SEP), you may have to wait until the next OEP begins in late 2025. Here’s what happens if you don’t take action before the deadline.

Common SEP triggers include:

• Loss of other coverage

• Marriage or divorce

• Birth or adoption of a child

• Moving to a new ZIP code or state

Why Does It Matter Who Runs Your Marketplace?

If your state uses a state-based marketplace, your:

• Enrollment dates may be longer or more flexible

• Health insurance plan options may be broader or include regional carriers

• Application process may take place on a different website (not HealthCare.gov)

Looking for Health Insurance?

The best way to get the right plan for your needs is by working with a licensed health insurance agent. At EZ, our team:

• Works with top-rated insurance companies in every state

• Can help you access premium subsidies and tax credits

• Will walk you through all your health insurance options—federal and state-based

• Does all the heavy lifting for you—at no cost

To get free instant quotes, simply enter your ZIP code in the bar above, or to speak to a local agent, call 855-677-0157.

Luckily, you won’t have to feel alone during this OEP, because EZ.Insure is here to help! EZ.Insure makes the enrollment process stress-free and simple. Our easy-to-use platform provides free quotes and side-by-side comparisons of all the available health plans in your area. We also have a team of dedicated agents who are always on hand to help guide you through the process or answer any questions, so you can leave feeling confident in your coverage. To help you feel even more prepared, we’ve compiled a brief list of helpful tips so you can tackle this OEP with ease.

1. Choose an Unbiased Agent

Who you choose to work with when looking for a health insurance plan is a very important decision, and plays a big part in finding a comprehensive, affordable plan. It’s important to work with a licensed, knowledgeable agent who is not connected to a certain type of health insurance plan or insurance company, so you can get an unbiased look at all available options in your area. 

EZ’s agents work with the top-rated health insurance companies in the nation, and we guarantee that we will compare all plans in your area so that you can find the perfect plan. And not only are our agents independent, but they are also always up-to-date on newer healthcare plans, so they can provide you with all the information that you need before you make your decision.

2. Consider ALL of Your Options

After choosing to work with an EZ agent, you can simply ask them to research every option that you have, as well as help you weigh all the pros and cons of each plan. There are many different types of healthcare plans available, including PPO plans, HMO plans, or metal tier plans; if you’re not sure what’s best for you, an EZ agent will go over all of these different plan types, and will not try to limit you to a certain plan. We will lay all of your options on the table and review the coverage and cost of each one.

3. Ask the Right Questions

When it’s time to start searching for plans, think ahead of time about what you want to ask your agent, and what is important to you in a plan. In addition to asking about prices and coverage options, have a list of questions you want to ask, like: 

• Is advanced primary care included in the plan?  
• Can you keep your current doctor? 
• Do you qualify for subsidies for any of the plans? 
• Can you see doctors outside of your network?
• Is mental health care (or anything else you’re interested in having covered) covered?
• Is a higher deductible or lower premium plan better for you?

4. Find the Plan That Has the Most Value

People often choose the cheapest plan available, but this cheapest plan might not have the best benefits available for the price. A good health insurance plan will come from a quality carrier, provide comprehensive benefits, allow you to see the doctors you want to see, and have affordable co-pays. And remember, if you go for the cheapest plan available, you might end up paying more out-of-pocket when you use medical services. Our agent will review your medical needs and budget, and search for a plan that will check all the boxes for you.

Need Help? EZ’s Got You Covered

The health insurance Open Enrollment Period will be open from November 1st through January 15 (depending on your state), so now is the perfect time to reconsider getting a health insurance plan, or to look closely at your current one to make sure it will cover all of the above-mentioned costs. And if your plan doesn’t cover everything you need it to, it’s time to find a plan that does, so you can save as much money as possible. 

If you’re shopping for a plan, your best bet is to speak to a licensed EZ agent. Our agents work with the top-rated insurance companies in the nation, so we can compare plans in minutes. We will not only find a plan that has all the benefits you’re looking for, but we will also make sure the plan meets your financial needs. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 855-677-0157. No obligation.

What Types Of Plans Are Available?

There are a lot of plans – and we mean A LOT – of different plans out there to choose from. There are metal tier plans, HMOs, PPOs, POSs, EPOs, and more. Each plan offers different levels of flexibility, coverage options, and rates; your available options also depend on where you live, so be sure to ask your EZ agent which plans are available in your region. We will gladly go over every single option and discuss the difference between each plan, so we can help you determine which one is right for you and your family.

What Are The Metal Tiers?

Health plans available on the ACA Exchange are separated into four metal tiers. These tiers do not indicate the level of care you will receive; rather, the tiers let you know how much you will pay for care and how much your insurer will pay. The tiers are:

• Bronze– Lower monthly premiums, but a higher deductible and copays. You will usually pay an average of 40% of costs of care, and your insurer will pay 60%. 
• Silver– Moderate monthly premiums and moderate medical costs. You will pay 30%, and your insurer will pay 70%.
• Gold– Higher monthly premiums with lower out-of-pocket costs. You will pay 20% and your insurer will pay 80%. 
• Platinum– Highest monthly premiums and lowest out-of-pocket costs. You will pay 10% and your insurer will pay 90%. 

We will be able to go over this in more detail, including what each type of plan will cover and how much you will pay, so you can have a better understanding of how these plans work.

Can I Add Supplemental Insurance?

Dental and vision are considered supplemental insurance plans; some health insurance plans do not offer these, so you will have to ask if they are part of the plan you are looking into. If they are not, we can help you find affordable dental and vision plans. 

What is A HDHP & Will It Work For Me?

High deductible health plans are exactly what they sound like: these plans have high deductibles, but in exchange, you will have low affordable monthly premiums. These plans are generally for healthy people who only see the doctor for annual physical exams and do not have any chronic conditions that require constant medical attention, and who will most likely not have to pay their whole deductible. For 2022, the Internal Revenue Service has defined a HDHP as any plan with a deductible of at least $1,400 for an individual, or $2,800 for a family.

How Are Medications Covered?

Figuring out the cost of your prescriptions can be a little complicated since different insurance companies can charge differently for the same drug – some drugs might even be covered differently by the same insurer depending on the plan you choose. Basically, insurers put medications into  a drug formulary, which is divided into four tiers:

1. Tier 1– Inexpensive generic drugs
2. Tier 2- Brand name drugs and more expensive generic drugs
3. Tier 3– Non-formulary drugs, generic or brand name
4. Tier 4- Specialty drugs

To find out which plans cover your medications and how much you will be charged based on their placement in the insurer’s drug formulary, you need to speak with an EZ agent. We will review each plan available in your area and their drug formularies to make sure that your medications are covered, and that they will not cost you an arm and a leg. 

What About Out-of-Network Coverage?

Some plans, like HMOs, will not cover out-of-network coverage, but PPO and POS plans do cover out-of-network coverage in case of an emergency. If you travel or visit family in other parts of the country often, you’ll definitely want to consider a plan that covers out-of-network emergencies; otherwise, if you have an accident while away from home, you could be stuck with a bill that you have to pay out-of-pocket.  

Do I Need Referrals?

With some plans, you’ll need a referral from your primary care physician (PCP) to see a specialist, like a gastroenterologist or an orthopedic doctor. If you want to skip this step and see a specialist whenever you feel necessary, we can help you find a plan that does not require a referral. You’ll have more flexibility with a plan that doesn’t require referrals, and you won’t have to pay a PCP copay just to get a referral to see a specialist.

There are so many things to think about when looking for a health insurance plan for you and your family. Do you want more flexibility? Supplemental insurance? Cheaper prescriptions? The easiest way to find the right plan for you and get the answers to these questions is to work with an EZ agent. We will compare plans, go over every option, discuss your needs, and help you sign up for the plan you need, all at no cost to you. Our services are completely free, with no hassle and no obligation. Speak to an EZ agent now, before the OEP ends! Get free health insurance quotes by entering your zip code in the bar above, or to speak with a local agent, call 855-677-0157 

What The ACA Has Done for Millions

Before the ACA was passed in 2010, you could have been denied a health insurance plan simply because you had a pre-existing condition. That meant a huge amount of Americans were unable to find affordable health insurance: approximately 43% of U.S. households report having pre-existing conditions. And indeed, health insurance was out of reach for many before 2010: when the ACA went into effect approximately 46.5 million people, or 17.8% of the total nonelderly population, were uninsured. 

But the ACA, with its Patients’ Bill of Rights that prohibits insurers from discriminating based on pre-existing conditions or revoking your coverage because of an unintentional mistake on an application, changed everything. 31 million people have enrolled in health insurance plans through the Affordable Care Act since it was enacted, and that is a huge accomplishment! But there has been criticism over the years that health insurance, while available to everyone, was still not accessible to everyone – but that has all changed. 

President Biden’s American Rescue Plan

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Earlier this year, President Biden passed the American Rescue Plan (ARP), which has made health insurance far more affordable for far more people. It extended premium tax credits to more Americans by allowing people who earn over 400% of the federal poverty level to receive subsidies to purchase health insurance through the ACA Marketplace; it also requires that Americans pay no more than 8.5% of their income on health insurance premiums, and provides a larger tax credit to people who already receive financial assistance.

What all of this means is cheaper premiums! For most people, premiums will be at least $50 per month cheaper, while some people might pay $0 in premiums. With the new law:

• An individual making $19,000 or less per year will not have to pay a monthly premium for health insurance. 
• Couples who earn less than $70,000 together will save $1,000 per month on their health insurance monthly premiums. 
• A family of 4 with an income of $90,000 will pay about $200 less in health insurance premiums.

The bottom line is you can never be denied health insurance coverage during the Open Enrollment Period; not only that, but insurance is now affordable for everyone, so there is no reason you can’t get a plan that is right for you. It is important to note, though, that the Open Enrollment Period is the only time you will be able to get coverage: if you miss the OEP, you will have to wait until next year’s OEP, unless you qualify for a Special Enrollment Period. Don’t let this period pass you by – it’s the perfect (and only) time to get a great affordable health insurance plan!

Need Help?

If you have any further questions, or need help finding a plan during the Open Enrollment Period, an EZ agent can help you. We will provide you with a local licensed agent who will search all available plans in your area and find the best one for your medical and financial needs. We will also double check to see if you qualify for any subsidies to save you even more money. All of our services are done in minutes and at no cost to you. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local licensed agent call 855-677-0157.

You Could Get Stuck With Your Current Plan

This might not necessarily be a bad thing if you are happy with your current plan, but if your plan isn’t quite right for you, you will unfortunately be stuck with it until the next Open Enrollment Period opens up again.

You’ll Miss The Opportunity To Change Your Plan

If you don’t take the opportunity to review your current plan and do nothing during the Open Enrollment Period, you won’t be able to change your plan. What this really means is that your health insurance might:

• Not provide enough coverage for the following year, which will cost you money.
• Have too much coverage that you don’t need, essentially leaving you to pay for insurance that you don’t need.
• Be too expensive. If you don’t change your plan during the OEP, you’ll be stuck with the rise in rates and costs for the following year. 

Options Are Limited Afterwards

If you don’t have health insurance and are looking to enroll in a plan, but you do nothing during the Open Enrollment Period, you won’t be able to get a Marketplace or exchange health insurance plan – in other words, you won’t be able to get an ACA-compliant health plan. With that being said, you do have other options even if you miss the OEP, but you should be aware that they are very limited. For example, you can opt to get a short-term health insurance plan that covers the essentials and nothing more; this type of insurance is temporary and not ideal for those who require more comprehensive coverage, or have health conditions. Short term plans are not guaranteed issue, meaning they do not cover pre-existing conditions.

You Will Need To Qualify For an SEP

The only way to get an affordable health insurance plan that is ACA-compliant outside of the OEP is to qualify for a Special Enrollment Period, or SEP. A Special Enrollment Period is only available to those who have a qualifying life event, including:

• Change in residence (moving to a different zip code or county)
• Change in household size (having a baby or adopting a child, getting married, or getting divorced)
• Loss of health insurance (losing employment, turning 26 and getting kicked off of a parent’s plan, or a death in the family)
• Changes in income

Don’t Do Nothing…

Compare plans! There’s no harm in comparing plans and seeing your options before the Open Enrollment Period ends. But we get that it can be a headache to try and research all the different plans around, so we’re here to help! Our highly trained agents will take the time to talk with you and thoroughly explain all of your options. Once you are ready to enroll, they will search through all the plans in your area and find the right plan for you, making sure the plan fits your needs and budget. EZ always provides you with your own personal agent, so there’s never any need to worry about bouncing around from agent to agent or getting hassled by endless sales calls. To get started, enter your zip code in the bar above, or to speak to an agent directly, call 855-677-0157.

Qualifying Life Events

You have 60 days to change your plan if you:

• Got married
• Had a baby, adopted a child, or took in a foster child
• Got divorced or legally separated. However, if you do not lose coverage due to divorce or legal separation, then you do not qualify for a Special Enrollment Period.
• Had someone on your marketplace plan die
• Changed residence. If you move to a new home in a new ZIP code or county, move to attend school, are a seasonal worker and move between job and home, or move from a shelter or other transitional housing to a permanent residence, you will qualify for an SEP.
• Lost your health insurance. This includes losing job-based coverage, losing a plan you bought yourself, losing eligibility for Medicaid or Medicare, and losing coverage through a family member.
• Gained membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
• Became newly eligible for Marketplace coverage because you became a U.S. citizen
• Left incarceration
• Started or ended service as an AmeriCorps State and National, VISTA, or NCCC member

Short-Term Medical Plans

If you do not qualify for any of the life events listed above, all hope is not lost. You can enroll in a short-term medical plan. Short-term health insurance provides fast, flexible insurance with many benefits. These plans can be extended up to 3 years, and you can pick your deductible amount from many options. You are also able to drop coverage without a penalty if you want to change to a long term insurance option. Premiums are lower than ACA health insurance plans, and you get coverage as soon as a day after applying.

It is important to understand that short-term insurance is temporary and not ideal for those who require more comprehensive coverage or have health conditions. Short term plans are not guaranteed-issue, meaning they do not cover pre-existing conditions. They only cover the basics.

Do you qualify for a special enrollment period? If not, are you considering a short-term health insurance plan to hold you over until open enrollment begins? EZ.Insure can help. We offer accurate health insurance quotes based on your specific region, free of charge. That’s right. We will provide you with an agent who will compare all available plans for you, and help you choose a health insurance plan that is based on your health needs and budget, for free. To get your free quotes, simply enter your zip code in the bar above, or to speak to an agent, call 855-677-0157

The unfortunate downside is that if the deadline is missed, then they must wait until next year. However, certain qualifying life events exempt an individual from this rule. You can learn more about that here. <link to SEP article>

For Employees

Open enrollment for the 2019 period will start Friday, November 1, and it will run until Sunday, December 15, 2019.

With your employment-based policy, your staff should receive reminders in the mail, but make sure to either talk to them one-on-one or send them an email yourself. 

Health coverage is important, and taking the time to reach out will send a positive message to your employees.  They will appreciate your knowledge, guidance, and interest in their well-being. 

For Business Owners

You do not have an “open enrollment” period to make changes to your company’s group health policy. You can make changes whenever you’d like. 

If you want to change your business’ policy, you can (usually) cancel your coverage at any time, but the insurance company prefers to be notified at least 30 days in advance. It would be courteous to let your employees know as well. 

For these changes, it’s good to review the pros and cons of joining an HRA or switching to a different policy. Both are valid options, but the choice ultimately falls on what would be best for your company’s future.

Don’t worry about big insurance decisions; EZ.Insure offers solutions. Your agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing replies@ez.insure, or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.