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Health Care Reform:

Health Insurance & Affordable Care Act

Insurance Marketplaces: What Your State Decides

Every state has access to a health insurance Marketplace, also called an Exchange.

The Marketplace is where people who don't have health insurance through an employer, Medicare, Medicaid, Tricare, or the VA can enroll in a comprehensive health plan. Small businesses with 50 or fewer workers can buy health insurance from the Small Business Health Options Program (SHOP) Marketplace. The main way to use the Marketplace is online, but you can also access it by phone or in person.

Your health benefits and costs may differ in important ways from those of a family like yours in another state. You should  compare plans on your state’s Exchange to learn what choices are available to you.

What's the Same in Every State?

When it comes to your health care options on the Marketplace, some things are the same in every state.

Basic coverage. The U.S. government sets basic guidelines for essential benefits. Every health plan sold in the Marketplace has to offer them. They include emergency care, pediatric care, maternity care, lab testing, and more.

Protections. There are many new protections under the law. Some include upper limits on how much you have to spend before your insurance company covers the cost of all of your care.  Also, no plan can charge you more for insurance coverage based on your health or on whether you're a man or a woman.

Four levels of coverage. Every Marketplace will rank the types of plans according to the level of benefits they offer, from platinum (the most) to bronze (the least.) There's also a special plan for young adults.

The Decisions Your State Can Make

Aside from those basic requirements, states have a lot of control over what to include in their health coverage.

Which insurance companies get to sell on their Marketplace? States that set up their own Marketplace can choose insurance companies and can set tougher rules for coverage than the federal guidelines require.

How many insurance companies can sell?  Some states,  like California, are limiting the number of insurance companies selling on their Marketplace. They hope it will improve the quality of the plans offered. Other states are taking a different approach. For instance, Colorado allows any insurance company certified as a Qualified Health Plan to sell plans.

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