The State Marketplace Network (SMN) includes twenty-one individual state health insurance marketplaces from across the country that each facilitate access to more affordable, comprehensive health insurance for consumers.
Marketplaces are integral to achieving the nation’s continuum of coverage afforded through the 3 M’s — Medicare, Medicaid, and Marketplace. As part of the nation’s coverage infrastructure, all marketplaces play a key role in ensuring individuals have access to health insurance when needed, regardless of health status, age, or income. Marketplaces ensure that eligible people have lower premiums and lower out-of-pocket costs through private health insurance that must have all consumer protections afforded by law.
State-based marketplaces are created for and within the communities they support, positioning them to meet the unique needs of their consumers. As a result, state marketplaces can target in-person, community-based assistance to support consumers while also coordinating with other health programs to offer seamless enrollment in coverage.
Moving the Individual Market from Unpredictable to Dependable
The marketplaces are critical to realizing the goal of increased access to and affordability of coverage through the implementation of groundbreaking market reforms and the following key consumer protections:
- Increasing affordability by ensuring those eligible have access to premium tax credits and cost-sharing reductions that lower costs of coverage and care
- Guaranteeing access to health insurance regardless of pre-existing conditions
- Ensuring comprehensive coverage through the adoption of the essential health benefit package, without limits on critical services
- Providing economic independence by ensuring a dependable and affordable market for those who purchase insurance on their own, which eliminates job lock and supports sole proprietors and early retirees
- Supporting our health care infrastructure across the country by reducing uncompensated care
Increasing Access to Coverage
As part of the 3 M’s, the marketplaces have increased the availability of more affordable, reliable coverage for millions of people for whom it was previously out of reach. The following national data on health insurance and the uninsured offer key insights into the marketplace impact:
- By mid-January 2024, over 21 million people had selected plans through the federal and state-based marketplaces, which accounts for 16 million renewals and 5 million new enrollees during open enrollment.
- The uninsured rate for people under age 65 declined from 17.5% in 2009 to 7.7% in early 2023 after the marketplace open enrollment period.
- Approximately 5.8 percent of adults ages 18–64 reported having coverage through an insurance marketplace in early 2023, which is an increase from 4.4 percent in 2020.
- Between 2020 and 2023, those making less than $15,000 and individuals making between $30,000 and $60,000 annually experienced the greatest reductions in uninsurance.
With health insurance, people can focus on staying healthy with access to free preventive services that allow for earlier diagnoses and treatments and, if needed, receive prompt attention for injury or illness with financial protections against unexpected medical costs.
State Marketplace Innovation
The state marketplaces have flexibility to provide more tailored programs for their populations and create ways to ensure consumers have more affordable, comprehensive coverage that provides meaningful access to care. State marketplaces use different governance structures, can target specific populations, and can determine how they want to improve coverage in their respective states. For example:
- Focusing on lower costs. More than half of the state marketplaces have lowered costs through innovative programs to reduce premiums and other cost-sharing for consumers. As health care prices continue to rise, these efforts are even more important.
- Expanding access to coverage for specific populations. Several state marketplaces have identified populations that need additional support to gain coverage, such as childcare workers, those who cannot meet citizenship documentation requirements, and others. Leveraging the state marketplace to create coverage solutions for these populations improves access to critical care and decreases burdensome uncompensated care rates for providers.
- Easing enrollment. All state marketplaces seek to minimize burdens on consumers to simplify their enrollment and ensure continued coverage, and a few states (California, Maryland, and Rhode Island) have adopted auto-enrollment policies for those transitioning between marketplace and Medicaid programs. These policies, introduced to help keep people covered by ensuring data transfers and assisting with plan selection, highlight state ingenuity and cross-agency coordination.
- Improving coverage. Many of the state marketplaces are leveraging standard plan design to meet their consumers’ coverage needs. For instance, Massachusetts is ensuring pre-deductible coverage of diabetes care, while New York is eliminating cost-sharing for individuals with diabetes and improving coverage of maternal and post-partum services. Pennsylvania is leveraging a data-driven approach to promoting health equity and California is using quality measures designed to ensure consumers are “getting the right care” from their health plans. Additionally, Idaho’s marketplace is increasing consumer health literacy so people can effectively use their coverage.
- Supporting health plan competition. Several states note marketplace coverage changed the individual market such that there is increased competition among plans that allow for more consumer choice.
- Bolstering small business. Some state marketplaces also run Small Business Health Option Programs (SHOPs), which offer important tools and resources to small businesses that wish to offer coverage to their employees. The District of Columbia has built one of the most robust SHOPs, which supports over 100,000 enrollees.
Millions of individuals have benefitted from having access to marketplace coverage when they needed it. As marketplaces celebrate a full decade of ensuring consumers can enroll in and benefit from more affordable, comprehensive, dependable health plans, states are eager to build upon their progress.
