Under the Affordable Care Act (ACA), each state has the option to establish a
state-based exchange, also known as a state marketplace, or to use the federal exchange, also known as the Health Insurance Marketplace.

A state-based exchange is run by the state government, and residents can enroll in health insurance plans offered through the exchange. The state-based exchange may have its own website and call center, and may offer additional services such as assistance with enrollment, customer service, and outreach.

On the other hand, the federal exchange is run by the federal government through the Department of Health and Human Services (HHS). If a state chooses not to set up its own exchange, residents in that state can enroll in health insurance plans offered through the federal exchange. The federal exchange also has its own website and call center, and provides enrollment assistance and customer service.

One key difference between the state-based and federal exchanges is that states with their own exchange have more control over the plans and insurers that participate in the exchange, as well as the design and structure of the exchange itself. In contrast, the federal exchange is subject to federal regulations and oversight.

Another difference is that the availability of subsidies to help pay for health insurance premiums may vary depending on whether a state has its own exchange or uses the federal exchange. In general, residents in states with their own exchange may have access to state-funded subsidies in addition to federal subsidies, while residents in states that use the federal exchange may only be eligible for federal subsidies.

The following states (and the District of Columbia) have their own state-run exchanges:

• California (Covered California)
• Colorado (Connect for Health Colorado)
• Connecticut (Access Health CT)
• District of Columbia (DC Health Link)
• Idaho (Your Health Idaho)
• Kentucky (Kynect)
• Maryland (Maryland Health Connection)
• Massachusetts (Massachusetts Health Connector)
• Minnesota (MNsure)
• Nevada (Nevada Health Link)
• New Jersey (Get Covered NJ)
• New Mexico (beWellnm)
• New York (NY State of Health)
• Oregon (Oregon Health Insurance Marketplace)
• Pennsylvania (Pennie)
• Rhode Island (Health Source RI)
• Vermont (Vermont Health Connect)
• Washington (Washington Healthplanfinder)

Note that some of these states may use the federal exchange, Healthcare.gov, for certain functions such as eligibility determinations or enrollment in certain types of plans.