You Move to a New State: State-Specific Information on the Affordable Care Act

Where Can I Find the Health Insurance Marketplace in My State?

The Health Insurance Marketplace is also known as the Health Insurance Exchange (or HIE). The Marketplace was created by the Affordable Care Act as a way for people to buy health insurance. The Marketplace is like Travelocity or Orbitz, except you can buy health insurance rather than book travel and hotels. For more information about the Health Insurance Marketplace, click here.

Each state has its own Marketplace. Most states have a different name for the Marketplace. For example, in California the Marketplace is called Covered California. In Hawaii, the Marketplace is called Hawaii Health Connector.

To find the Marketplace in your state, go to: https://www.healthcare.gov/get-coverage/

Who Runs the Marketplace in My State?

The Affordable Care Act gave each state the option to:

  1. Create and run its own Marketplace
  2. Partner with the federal government to run its Marketplace
  3. Merge with other state Marketplaces
  4. Choose not to set up an Marketplace—in this case, the federal government runs the Marketplace for the state

To find out how your state Marketplace is run, go to: http://www.statehealthfacts.org/comparemaptable.jsp?ind=962&cat=17

Is My State Expanding its Medicaid Program?

Medicaid is a health insurance program for certain people with low incomes. These people are:

Before the ACA, states had different rules about who qualified for Medicaid. It depended on whether you had children, if you had a disability, whether you were male or female, your age, and how much money you made. The ACA makes it easier to qualify for Medicaid. This is called Medicaid expansion.

Medicaid expansion increases the number of people who can get Medicaid. Medicaid expansion allows everyone younger than 65 to qualify for Medicaid if they make less than 138% of the federal poverty level (about $16,242 a year for a single person and $33,465 a year for a family of four in 2016). Because of Medicaid expansion, many people who were not allowed to apply for Medicaid can now qualify (including single men). To read more about Medicaid expansion, click here.

In June 2012, the Supreme Court decided that states did not have to expand Medicaid. They said each state could decide whether or not to expand their Medicaid program.

Some states are expanding their Medicaid programs, and other states are against Medicaid expansion. To find out if your state plans to expand Medicaid, go to: http://familiesusa.org/product/50-state-look-medicaid-expansion

Are the Essential Health Benefits the Same in Every State?

Essential health benefits, also called EHBs, are ten health care service categories that must be covered by most insurance plans.

The ten essential health benefits are:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Laboratory services
  5. Maternity and newborn care
  6. Mental health and substance use disorder services including behavioral health treatment
  7. Pediatric services including oral and vision care
  8. Prescription drugs
  9. Preventive and wellness services
  10. Rehabilitative and habilitative services and devices

To find out more about the essential health benefits, click here.

The ACA requires most insurance plans to cover the essential health benefits. However, it does not tell the insurance plans how much they have to pay, or how many visits they have to pay for.

In 2011, each state figured out the details that the insurance plans would have to follow. This is called the benchmark plan. The benchmark plan represents the typical types of coverage for the essential health benefits. The benchmark plan is the standard that insurance companies must follow.

Where Can I Find My State’s Benchmark Plan?

States could choose a benchmark plan from the following:

If a state did not select a plan, the default benchmark plan is the small group plan with the largest enrollment in the state.

To find detailed information about your state’s benchmark plan, go to: http://cciio.cms.gov/resources/data/ehb.html

Where Can I Find More Information?

HealthCare.gov, a website created by the Department of Health and Human Services with state-specific health care information:
http://www.hhs.gov/healthcare/facts-and-features/state-by-state/index.html