Q. What type of health insurance exchange/marketplace does my state have?
A. As of the 2021 plan year, with enrollment that begins November 1, 2020, there are 15 fully state-run health insurance marketplaces (SBMs), six state-based marketplaces that use the federal platform (SBM-FP), six state-federal partnership marketplaces, and 24 fully federally-run marketplaces.
This page describes each state’s current exchange management approach. We’ve also included, below, a summary of how this has changed over time, as several states have transitioned to or from HealthCare.gov over the years. These transitions are ongoing, with several happening for 2021.
There was initially a trend of states abandoning their own enrollment platforms and opting for HealthCare.gov instead. But we’re seeing the opposite happening in the 2020s, with a growing number of states choosing to leave HealthCare.gov and operate their own exchanges with their own enrollment platforms. This gives a state added flexibility (for example, the opportunity to extend open enrollment) and control, and states are also finding that it’s less costly to operate their own exchanges.
Here’s how each state’s exchange is run, as of 2021:
SBMs: State-run marketplaces (these states have their own enrollment websites)
- District of Columbia
- New Jersey
- New York
- Rhode Island
SBM-FPs: State-based marketplaces that use the federal enrollment platform (HealthCare.gov)
- Kentucky (planning to transition to an SBM by fall 2021)
- New Mexico (state runs its own small business SHOP exchange, and plans to have a fully state-run individual exchange by fall 2021).
- Maine* (pending federal approval, Maine will have an SBM-FP as of fall 2020 and an SBM in a future year)
- Virginia* (legislation has been enacted to create a state-run exchange by 2023)
Partnership exchanges (these states use the federal HealthCare.gov enrollment platform)
Federally-run marketplace (these states rely entirely on HealthCare.gov)
- North Carolina
- North Dakota
- South Carolina
- South Dakota*
[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.]
How has management of the marketplaces changed over time?
The exchanges/marketplaces debuted in the fall of 2013, providing coverage for the 2014 plan year. Since then, several states have made changes to their marketplace management. Some have opted to move away from HealthCare.gov and operate their own exchange, while others have taken the opposite course, abandoning a state-run enrollment platform in favor of using HealthCare.gov.
For the 2015 plan year:
- 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 (SBM-FPs) prior to the 2015 open enrollment period (Nevada has since switched back to having a fully state-run exchange).
For the 2016 plan year:
- Hawaii opted to transition to an SBM-FP, abandoning its state-run enrollment platform (as noted below, Hawaii dropped the state-run aspect altogether the following year).
For the 2017 plan year:
- Arkansas switched from having a state-federal partnership exchange to an SBM-FP (enrollment continued to be via HealthCare.gov, so there was no change from a consumer perspective).
- Hawaii switched from an SBM-FP to the federally-run exchange (enrollment continued to be via HealthCare.gov, so there was no change from a consumer perspective).
- Kentucky switched from a state-based exchange to an SBM-FP (Kentucky is planning to revive its fully state-run exchange and Kynect enrollment platform in time for the 2022 plan year).
For the 2020 plan year:
Exchange management stayed unchanged for a few years. But several changes took effect in the fall of 2019, for the 2020 plan year:
- Nevada switched to a fully state-run exchange, after having an SBM-FP since 2015. Nevada enrollees now use Nevada Health Link instead of HealthCare.gov.
- New Jersey transitioned to an SBM-FP, after having a federally-run marketplace since 2014 (federal approval for this was granted in October 2019; enrollees continued using HealthCare.gov, but as described below, the state will no longer use HealthCare.gov as of the 2021 plan year).
- Pennsylvania also transitioned to an SBM-FP, after having a fully federally-run marketplace in previous years. And just like New Jersey, Pennsylvania will stop using HealthCare.gov in the fall of 2020.
For the 2021 plan year:
The following changes will occur in the fall of 2020 (open enrollment starts November 1, 2020; these changes will be in place by that time):
- Pennsylvania will have a fully state-run exchange, called Pennie (residents will no longer use HealthCare.gov).
- New Jersey will have a fully state-run exchange, utilizing the GetCoveredNJ platform (residents will no longer use HealthCare.gov).
- Virginia will have an SBE-FP (residents will continue to use HealthCare.gov for enrollment, but Virginia plans to transition to a fully state-run exchange with its own enrollment platform by the 2023 plan year).
- Maine notified CMS that they planned to transition the state to an SBM-FP by the fall of 2020 (and possibly to a fully state-run exchange by the fall of 2021), and legislation was enacted in Maine in 2020 to move forward with that process. Maine is still awaiting federal approval for this transition, but is still planning for it to take effect before the November 2020 start to the open enrollment period. And it’s noteworthy that Maine did not receive federal Navigator funding in August 2020, presumably because the state will be operating its own state-run exchange (albeit with the HealthCare.gov platform used for enrollment) by the time open enrollment begins, meaning that Maine will be responsible for its own Navigator program funding.
Anticipated changes for the 2022 plan year and beyond:
New Mexico and Kentucky plan to have fully state-run exchanges by the fall of 2021, for enrollments in 2022 coverage. Both states have an SBM-FP in 2020, and will continue to use that approach in 2021.
Virginia plans to have a fully state-run exchange by the 2023 plan year.
Oregon, which has an SBM-FP, is also considering a future switch to its own enrollment platform.
Change to SHOP (small business) exchange management
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.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.