Health Exchanges

ROUGHLY A THIRD of states offer their own health care exchange. Residents of other states can use the exchange set up by the federal government at If you shop for health insurance on your own, you don’t have to buy through the exchanges. In almost all states, you can also purchase policies directly from insurance companies or through an insurance agent.

Sidestepping the exchanges probably won’t save you money. Indeed, if you purchase policies outside the exchanges, you won’t receive the tax credit that you might be eligible for. Still, shopping outside the exchanges could give you a wider choice. You can find policies, including those not offered through the exchanges, at sites such as and

Policies bought both inside and outside the exchanges must include the same essential benefits, and all must be categorized as bronze, silver, gold or platinum. Moreover, the same key principle applies: It’s illegal for an insurer to deny coverage because of preexisting conditions.

As you pick among policies, think carefully about the annual deductibles—which could be $2,000 or $3,000—and out-of-pocket maximums, and how you would meet that cost if you had a year with major medical expenses. For a health care policy to comply with the Affordable Care Act in 2024, the maximum out-of-pocket medical cost is $9,450 for individuals and $18,900 for families. This maximum, which doesn’t include the monthly premiums paid to buy the policy, should help many folks avoid excessive medical debt—and it ought to be a factor when deciding how big an emergency fund you need.

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