Q: What type of health insurance exchange does my state have?
A: As of the 2020 plan year, there are 13 state-based marketplaces, six state-based marketplaces that use the federal platform (SBM-FP), six state-federal partnership marketplaces, and 26 fully federally-run marketplaces.
But there were some changes for 2020, which was the first time since 2017 that there were changes to the structure of some of the exchanges. For 2020 enrollment, starting in November 2019:
- Nevada has a fully state-run exchange, after having an SBM-FP since 2015. Plans are available for preview on the state’s exchange website as of October 2019, and enrollees began porting their data from HealthCare.gov to Nevada Health Link as of September 2019.
- New Jersey has an SBM-FP, after having a federally-run marketplace since 2014 (federal approval for this was granted in October 2019). New Jersey plans to transition to a fully state-run exchange by the fall of 2020.
- Pennsylvania has transitioned to an SBM-FP, after having a fully federally-run marketplace in previous years. The state is in the process of transitioning to a fully state-run exchange by the fall of 2020.
New Mexico also plans to have their own fully state-run exchange by the fall of 2020, although they will continue to have an SBM-FP in 2020.
Oregon, which has an SBM-FP, is also considering a future switch to its own enrollment platform.
And Maine has notified CMS that they plan to pursue legislation in 2020 that would 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.
Prior changes to exchange structures
- 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. The same thing will be true in New Jersey in the fall of 2019—although the state will take on more oversight of the exchange, users will simply continue to use HealthCare.gov and likely won’t notice a change until the fall of 2020.
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; Nevada will switch back to their own fully state-run enrollment platform in the fall of 2019). 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.
Here’s how each state’s exchange is run, as of the fall of 2019 (for coverage effective in 2020):
(these states all use HealthCare.gov)
Maine* (possibly an SBM-FP as of 2021)
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 state-based marketplaces — SBMs — have their own enrollment websites)
State-based, federal platform (SBM-FP)
(these states all use the HealthCare.gov enrollment platform)
New Mexico (state runs its own small business SHOP exchange, and plans to have a fully state-run individual exchange by fall 2020).
Pennsylvania (planning to transition to an SBM by fall 2020)
(partnership exchanges use the HealthCare.gov platform for enrollments)