State-based Exchanges

State-based Exchanges

State-based exchanges refer to health insurance marketplaces that are established and operated by individual states in the United States under the Affordable Care Act (ACA), commonly known as Obamacare.

These exchanges are online platforms where individuals, families, and small businesses can compare and purchase health insurance plans.

Beginning January 1, 2014, individuals and small businesses across all states, including the District of Columbia, have been able to secure health and/or dental insurance through Individual or Small Business Health Options Program (SHOP) Health Insurance Exchanges. These exchanges are either managed by the states as State-based Exchanges (SBEs) or by the Federal government through the Federally-facilitated Exchange (FFE).

States interested in setting up an SBE must express their intention by sending a declaration letter to the Department of Health and Human Services (HHS), specifically to the Center for Medicare and Medicaid Services (CMS). Up until November 2014, states could also apply for federal grants to assist in establishing their SBE. Since 2014, the CMS’s Center for Consumer Information and Insurance Oversight (CCIIO) has begun issuing conditional approvals for states seeking to establish an SBE. Documentation like historic declaration letters and other relevant communications from states about setting up an Exchange is accessible online.

As of Plan Year 2024, there are 19 active SBEs and 3 State-based Exchanges operating on the Federal platform (SBE-FPs). SBE-FPs utilize HHS services for certain functions, particularly those related to eligibility and enrollment, while still maintaining control over other aspects such as the certification of Qualified Health Plans (QHP) and consumer outreach and assistance. SBE-FPs that also handle SHOP eligibility tasks are specifically indicated with an asterisk next to their names.

Key Points:

Here are some key points about state-based exchanges:

Customization

Local Control and Customization

State-based exchanges allow states to have more control over their insurance markets. States can tailor the exchange to meet local needs and preferences, and they often have more flexibility in selecting which insurance plans are offered.

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Federal vs. State Exchanges

Not all states operate their own exchanges. Some use the federal exchange platform (Healthcare.gov), while others may partner with the federal government in various ways. State-based exchanges are an alternative to these federal options

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Functionality

These exchanges provide a marketplace for health insurance where consumers can compare plans based on price, benefits, and other factors. They also offer tools and resources to help consumers understand their options and make informed decisions.

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Enrollment and Eligibility

State-based exchanges facilitate the enrollment process for health insurance and help determine eligibility for insurance subsidies or Medicaid.

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Variation Among States

The features and operation of state-based exchanges can vary significantly from state to state. This variation is due to differences in state regulations, insurance markets, and political environments.

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Impact on Insurance Coverage

State-based exchanges aim to increase access to affordable health insurance, improve competition among insurers, and ultimately expand health coverage within the state.

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Financial Assistance and Subsidies:

These exchanges also play a critical role in administering federal subsidies and financial assistance to help lower the cost of insurance for eligible individuals and families.

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Continuous Evolution

State-based exchanges continue to evolve in response to changes in federal health policy, state-specific needs, and the dynamics of the health insurance market.

State-based exchanges for plan year 2024:

Below is a list of the SBEs and SBE-FPs, for Plan Year 2024 and where available, a state’s declaration letter, HHS/CMS’ conditional approval letter, and a State’s Exchange website link. For additional information, please contact the State directly.

State-based exchanges on the federal platform for Plan Year 2024:

Click a tile to access a pdf on any of the following Ambetter member resources.

States seeking to transition to a State-based Exchange Plan Year 2025:

    Georgia