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Health insurance options vary by state
When it comes to health insurance in the United States, each state (and the District of Columbia) has taken its own distinct approach to regulating health policy.
As a result, your health insurance coverage options and access to affordable coverage will vary dramatically depending on where you live.
In the pages of this state health insurance guide, we’ve provided a detailed look at each state’s approach to health policy. When you select your state, you can expect to learn about your state’s:
- approach to providing an ACA marketplace enrollment platform,
- efforts to improve affordability of ACA-compliant coverage,
- implementation of ACA’s Medicaid eligibility expansion,
- regulation of short-term health insurance,
- rules and regulations that protect Medicare enrollees
- and more.
State health insurance guides
State reception to and implementation of ACA’s provisions
In many ways, the private health insurance industry is much more uniform from one state to another now that the ACA has provided a nationwide regulatory framework — all carriers and plans must conform to the requirements laid out in the ACA.
But there are still vast differences in terms of available options: In 2021, the number of carriers participating in each state’s health insurance exchange ranges from one to twelve. And average unsubsidized benchmark plan premiums vary from $307/month (Minnesota) to $791/month (Wyoming).
Lawmakers have also given state insurance departments varying levels of oversight in terms of state health insurance plan design and rates. In three states (Texas, Oklahoma, and Wyoming), annual premium rate review is left entirely up to HHS, and state regulators do not scrutinize rate change proposals. On the other hand, New York’s Department of Financial Services has slashed proposed health insurance rate increases seven years in a row using their regulatory authority.
ACA marketplace implementation
When it comes to the ACA marketplaces, almost half the states have opted to have at least some control over their own exchanges (establishing either a state-based exchange, a federally supported state-based exchange, or a partnership exchange), but more than half the states have chosen to have HHS run all aspects of their exchanges.
So while the ACA has brought a significant amount of uniformity to the health insurance industry nationwide, there are still vast differences from one state to another in terms of affordability and access to health coverage.
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Medicaid eligibility expansion varies by state
Because some states have not yet expanded Medicaid, about 2.2 million people are in what’s known as a coverage gap: They have no realistic access to health insurance, strictly based on the fact that they live in a state that hasn’t accepted federal funds to expand Medicaid.
Regulation of short-term health insurance
Short-term health insurance policies provide an affordable safety net for consumers who – due to changing circumstances – may find themselves temporarily without comprehensive health insurance or unable to afford comprehensive coverage.
But regulation of short-term health coverage varies dramatically from state to state. Each state that allows the sale of short-term plans has take its own unique approach to limiting the marketing of these temporary plans – with limits on initial duration of the plans and on number and duration of renewals by consumers.
Some state restrict the plans to the extent that carriers have decided to not market short-term health plans in state – while other states have adopted an outright ban of short-term health plans.
Regulation of Medicare coverage
As with each other type of health coverage, each state has taken its own approach to regulating the sale of specific types of Medicare coverage and implementing various consumer protections.
At the same time, the availability of Medicare plans varies by state. In some states, consumers will find a wide selection of carriers and plan options. In other states, there will be fewer plan options from which to choose.
Learn more about coverage in your state
Sweeping health reform legislation delivered a long list of provisions focused on health insurance affordability, consumer protections.
Explore other health insurance options.
The American Rescue Plan's premium-cutting subsidies
Find out how the American Rescue Plan will drastically cut marketplace health insurance costs for millions of Americans. Learn about $0 Silver premiums. Enroll now during a nationwide special enrollment period through August 15.Do you need short-term coverage?
If your budget is tight, but you’re not eligible for Medicaid or ACA subsidies, you may wish to consider short-term health insurance. Find out if short-term is right for you.
Check your eligibility for Medicaid
Thirty-six states and Washington, DC, made nearly 10 million low-income Americans eligible for Medicaid by implementing ACA’s Medicaid expansion. See if your state expanded eligibility. Then, use our Federal Poverty Level Calculator to check your eligibility for enrollment.
Medicare open enrollment 2021
Medicare’s open enrollment (Oct. 15-Dec. 7) is an annual opportunity to reevaluate your coverage – whether it’s Original Medicare with supplemental drug coverage, or Medicare Advantage – and make changes or purchase new policies if they want to do so. Learn more in our 2021 Medicare Open Enrollment Guide.
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