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When The Affordable Care Act was unveiled, states had many decisions to make. Whether to rely on the federal platform or set up a state exchange was one of them. Much of the outcome came down to which side of the issue the state’s political leadership was on. Republican-leaning states opted to leave control to the Federal government; some believing in opposition to the new law. By way of comparison, many Democratic, or “blue,” states attempted to set up exchanges of their own, with varying degrees of success. Below is a brief guide of healthcare exchanges by state. This information will help you understand health insurance exchange states as they are today, and provide some guidance on how to access the correct insurance exchange shopping platform for your state.

Health Insurance Exchange States by Type

Heath insurance exchange states fall into one of four categories: a State-Based Marketplace, Federally-Supported State-Based Marketplace, State-Partnership Marketplace, or Federally-Facilitated Marketplace.

State-Based Marketplace: States establish and run their own marketplace. Consumers enroll in coverage through a state-maintained website. States include: CA, CO, CT, DC, ID, MD, MA, MN, NV, NY, RI, VT, and WA.

Federally-Supported State-Based MarketplaceStates establish and run their own marketplace. However, consumers enroll in coverage through the Federal website. States include: AR, KY, NM, and OR.

State-Partnership MarketplaceThese states share responsibility with the federal government. They administer some in-person consumer assistance, while remaining functions are performed by the US Department of Health and Human Services. Consumers use to enroll.  States include: DE, IL, IA, MI, NH, and WV.

Federally-Facilitated MarketplaceUS Department of Health and Human Services performs all marketplace functions and consumers enroll through States include: AL, AK, AZ, FL, GA, HI, IN, KS, LA, ME, MS, MO, MT, NE, NJ, NC, ND, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, and WY.

Roughly 39 health insurance exchange states rely on the federal website for sign-up and enrollment.  States are likely to continue to evolve and change platforms. For instance, Delaware had a federally-facilitated marketplaces, but switched to a state-partnership marketplace system similar to Illinois. Nevada moves to state exchange beginning in 2020, whereas, Oregon started its own state exchange, but encountered problems that couldn’t be fixed. 

Whether you’re a resident of California or Texas, HealthMarkets is here to help you understand your options under the Affordable Care Act. During this year of enrollment, you can select a new plan or renew a former plan. Whatever the choice, and whatever the exchange, HealthMarkets can help you sort through the options and find the one with the most value for you. Plus, we can provide free help and guidance on plans, enrollment, subsidies, and more.



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