Which States Run Their Own Health Insurance Exchanges?

Under the Affordable Care Act, each state must have a health insurance exchange. The exchange, also known as the marketplace, is a platform that residents can use to shop for health insurance.

The exchange is used by people who need to purchase their own coverage and can also be used by some people who are eligible for Medicaid.

This article will describe who uses an exchange, how a state-run exchange differs from a federally run exchange, which states run their own exchanges, and how to access the exchange for your state.

Who Uses an Exchange?

People have the option to buy off-exchange coverage directly from an insurance company. But premium subsidies and cost-sharing reductions can only be obtained if a person buys their coverage through the exchange (or through an approved enhanced direct enrollment entity which can enroll people in the exchange via a third-party website).

Most Americans don’t need to use the exchange because they get coverage from an employer or Medicare, or enroll in Medicaid directly through their state’s Medicaid office.

But the exchanges are vitally important for several million people. During the open enrollment period for 2022 coverage, more than 14.5 million people enrolled in coverage through the exchanges nationwide. This was a record high, due in large part to the additional financial assistance provided by the American Rescue Plan (these subsidy enhancements have been extended through 2025 by the Inflation Reduction Act).

Those 14.5 million enrollees only include people who have private coverage through the exchange; the exchanges can also facilitate enrollment in Medicaid, but those enrollments are not counted among the exchange enrollment totals.

State-Run vs. Federally Run Exchanges

But when people refer to “your state’s exchange,” what exactly does that mean? Although every state has one official exchange, the specifics vary a bit from state to state.

The Affordable Care Act (ACA) provided funding and basic parameters for states to establish their own exchanges. But the law also clarified that if a state didn’t create an exchange, the federal government would step in and do it for them.

The ACA was enacted in 2010, and states had the next few years to set up an exchange if they wished to do so. These exchanges opened for business in the fall of 2013, but the majority of the states opted to have the federal government run their exchanges.

This was due to a combination of politics and practicality. Although some states supported the ACA and its mission to ensure access to affordable health coverage, they felt that it would be too challenging to run their own exchanges. So they opted to let the federal government step in on their behalf.

There were also numerous states where lawmakers and governors were generally opposed to the ACA, wanted to take a hands-off approach, and thus left the exchange operation to the federal government.

The federally run exchange is HealthCare.gov. It’s used in 33 states as of the 2023 coverage year. The other 17 states and the District of Columbia run their own exchanges.

Over the years, there have been some changes, with a few states transitioning to HealthCare.gov and a few others transitioning away from HealthCare.gov and creating their own exchanges.

Most recently, Kentucky, Maine, and New Mexico transitioned to having their own exchange platforms in November 2021, when open enrollment began for plans effective in 2022. Pennsylvania and New Jersey began operating their own exchanges in the fall of 2020, so the number of fully state-run exchanges grew from 13 in 2020 to 18 in 2022. And Virginia plans to be operating its own exchange by the fall of 2023, which will increase the number of fully state-run exchanges to 19.

Maine, New Mexico, Pennsylvania, and New Jersey had previously used HealthCare.gov for individual/family enrollments ever since the exchange system debuted in the fall of 2013. Kentucky had a successful state-run exchange for the first three years, transitioned to HealthCare.gov under Governor Matt Bevin, and then transitioned back to the fully state-run exchange (Kynect) under Governor Andy Beshear.

Which States Use HealthCare.gov?

For health coverage with a 2023 effective date, the following states use the federally run exchange. This means consumers in these states enroll in health coverage by using HealthCare.gov and contact the call center by calling 1-800-318-2596:

• Alabama
• Alaska
• Arizona
• Arkansas
• Delaware
• Florida
• Georgia
• Hawaii
• Illinois
• Indiana
• Iowa
• Kansas
• Louisiana
• Michigan
• Mississippi
• Missouri
• Montana
• Nebraska
• New Hampshire
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• South Carolina
• South Dakota
  
• Tennessee
  
• Texas
  
• Utah
  
• Virginia
  
• West Virginia
  
• Wisconsin
  
• Wyoming

Which States Run Their Own Exchanges?

For health plans effective in 2023, the following states run their own exchanges:

• California (Covered California)
• Colorado (Connect for Health Colorado)
• Connecticut (Access Health CT)
• District of Columbia (DC Health Link)
• Idaho (Your Health Idaho)
• Kentucky (Kynect)
• Maine (CoverME)
• Maryland (Maryland Health Connection)
• Massachusetts (Massachusetts Health Connector)
• Minnesota (MNsure)
• Nevada (Nevada Health Link)
• New Jersey (Get Covered NJ)
• New Mexico (bewellnm)
• New York (New York State of Health)
• Pennsylvania (Pennie)
• Rhode Island (HealthSource RI)
• Vermont (Vermont Health Connect)
• Washington (Washington Healthplanfinder)

Among the 33 states that currently use HealthCare.gov, three (Arkansas, Oregon, and Virginia) operate what’s called a state-based exchange on the federal platform, or SBE-FP.

These SBE-FPs can be thought of as a hybrid model. They use HealthCare.gov for eligibility determinations and plan enrollment, but the state oversees other aspects of the exchange, including health plan certification, Navigator funding, and consumer outreach.

Kentucky, Maine, and New Mexico had SBE-FPs for 2021 coverage, but began operating their own fully state-run exchanges for coverage effective in 2022 and future years. And as noted above, Virginia plans to transition to a fully state-run exchange in the fall of 2023, for coverage effective in 2024 and future years.

You Can Get There Via HealthCare.gov

Although the District of Columbia and 17 states run their own exchanges, HealthCare.gov is a “no wrong door” platform. Even if you’re in a state that doesn’t use HealthCare.gov, you can still start there and you’ll end up in the right place.

The screener page allows you to check your zip code or create an account. If you are in a state that has its own state-run exchange, you’ll see a message explaining that your state uses a different marketplace, along with a link to it.

Summary

Every state and the District of Columbia has a health insurance exchange. It is run by the state itself in some states, whereas other states use the federally run exchange. This can change over time as a state develops its own exchange or reverts to the federal exchange. You can find the exchange for your state at HealthCare.gov, whether it is run by your state or federally.

A Word From Verywell

If you need health insurance, your state’s exchange is the best place to turn. Starting at HealthCare.gov or one of the state-run exchanges listed above will mean that you’ll be shown only genuine health insurance plans that are compliant with the ACA, and you’ll have access to subsidies if you’re eligible for them (most people are).

Going directly to HealthCare.gov or a state-run exchange website is more reliable than doing a Google search for health insurance.

When you search online, you might end up at the correct exchange website. But you might also end up on a site that sells other types of coverage, like short-term health insurance. And it can sometimes be difficult to tell the difference between these plans and the ACA-compliant plans that you’ll find on your state’s exchange.