Q: What type of health insurance exchange does my state have?
A: As of 2018, there are 12 state-based marketplaces, five state-based marketplaces that use the federal platform (SBM-FP), six state-federal partnership marketplaces, and 28 federally-run marketplaces.
This is unchanged since 2017, and 2018 was the first time that none of the states made changes to the structure of their exchange for the new year.
In the first few years of exchange operation, there were several changes in various states’ exchange structure from one year to the next. Most recently, for 2017:
- Arkansas switched from having a state-federal partnership exchange to an SBM-FP.
- Hawaii switched from an SBM-FP to the federally-run exchange
- Kentucky switched from a state-based exchange to an SBM-FP
From a user perspective, the enrollment platform in Kentucky changed from Kynect to HealthCare.gov in 2017 (starting when open enrollment for 2017 coverage began, on November 1, 2016). But users likely didn’t notice a difference in Hawaii or Arkansas in 2017, as enrollees simply continued to use HealthCare.gov, just as they did in 2016.
There have been other transitions since the marketplaces first opened for business in the fall of 2013. Idaho used HealthCare.gov for enrollment in 2014, but switched to being a fully state-run exchange prior to the 2015 open enrollment period.
Nevada and Oregon both had state-run exchanges in 2014, but due to technical difficulties they both opted to become federally-supported state-based exchanges prior to the 2015 open enrollment period (the enrollment platform is HealthCare.gov, but the state still retains control over its own exchange). For 2016, Hawaii opted to do the same thing, and enrollments in Hawaii have been completed through Healthcare.gov since November 2015 (for 2017, Hawaii dropped the state-based aspect of their exchange, switching to a fully federally-run exchange).
Arkansas, Mississippi, and Utah were all running their own SHOP exchange (the platform for small businesses to enroll in coverage), but switched to using the federal platform or a direct-to-carrier process by 2018. But by that point, even the federal platform for small busines enrollment was no longer functioning as it had in past years, and small group enrollment had switched to a direct-to-carrier process in nearly every state.
Starting in the fall of 2019, Nevada plans to switch back to running its own exchange platform. And in the fall of 2020, New Mexico plans to operate its own exchange platform as well. Both states currently have state-based exchanges that use the HealthCare.gov enrollment platform.
Here’s how each state’s exchange is run, as of 2018:
(these states all use HealthCare.gov)
States with an asterisk have a marketplace plan management exchange. Their exchanges are federally-run, but the state retains oversight of the plans, and is active in certifying QHPs for sale in the exchange.
(these states have their own enrollment websites)
State-based, federal platform (SBM-FP)
(these states all use the HealthCare.gov enrollment platform)
(partnership exchanges use the HealthCare.gov platform for enrollments)