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:
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 individual/family major medical 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 13, and overall insurer participation grew again for 2022. In 2022, average unsubsidized benchmark plan premiums vary from $309/month (New Hampshire) to $762/month (Wyoming).
Lawmakers have also given state insurance departments varying levels of oversight in terms of state health insurance plan design and rates. In two states (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 every year since ACA-compliant plans became available, using their regulatory authority.
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.
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.
As of 2022, there are a dozen states that have not expanded Medicaid, and a coverage gap exists in 11 of them (Wisconsin has not expanded Medicaid under the ACA, but does provide Medicaid to adults with income up to the poverty level, ensuring that there is no coverage gap).
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.
Medicare is regulated at the federal level, meaning that states have little control over the plans that are available for consumers to purchase. But states do have some leeway to expand guaranteed issue access to Medigap plans. This is particularly important for beneficiaries under the age of 65.
Medicare Part D plan availability is fairly uniform across the country, although the specific plans and prices do vary a bit. But there is wide variation in terms of Medicare Advantage plan options; in some areas, consumers will find a wide selection of carriers and plan options, while other areas will have few or zero available Advantage plans.
Sweeping health reform legislation delivered a long list of provisions focused on health insurance affordability, consumer protections.
Find out how the American Rescue Plan has cut marketplace health insurance costs for millions of Americans, and how the Inflation Reduction Act extends the subsidy enhancements through 2025. Learn about $0-premium plans. Enroll during open enrollment (November 1 to January 15 in most states) or during a special enrollment period if you experience a qualifying life event.
Thirty-eight states and Washington, DC, have made more than 21 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’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 2023 Medicare Open Enrollment Guide.
Protect yourself from the soaring costs of dental procedures. Compare plan options to see premiums and deductibles that fit your budget.
Our state guides offer up-to-date information about ACA-compliant individual and family plans and marketplace enrollment; Medicaid expansion status and Medicaid eligibility; short-term health insurance regulations and short-term plan availability; and Medicare plan options.