What type of health insurance exchange does my state have?

Rules states must follow when transitioning to a state-run exchange

In the rulemaking process for 2024 coverage, HHS finalized a more lenient approval process timeline for states that are transitioning away from the federally-run exchange to establish their own exchange and/or exchange platform. However, some additional rules have since been finalized for the transition, effective in 2025 and future years.

The previous rules (pre-2024) required a state to have federal approval or conditional approval at least 14 months before the start of open enrollment if they were transitioning from an SBM-FP to an SBM, and at least three months before the start of open enrollment if they were transitioning from the FFM to an SBM-FP.

Under the new rules, the approval or conditional approval simply has to be received before the start of open enrollment. States will continue to go through the same intensive process of working with HHS to ensure a smooth transition and well-functioning exchange, but no longer have to obtain approval more than a year in advance to establish an SBM.

However, HHS has finalized a rule change for 2025 and future years that requires a state to operate an SBM-FP for at least one year (including the open enrollment period for that year) before operating a new SBM. This prohibits a state from transitioning directly from the FFM to an SBM.⁸

Here's how each state's exchange operates, as of the 2025 plan year (for enrollments that began in November 2024):

SBMs: State-run marketplaces (these states have their own enrollment websites)

• California
• Colorado
• Connecticut
• District of Columbia
• Georgia (SBM as of November 2024)
• Idaho
• Kentucky
• Maine
• Maryland
• Massachusetts
• Minnesota
• Nevada
• New Jersey
• New Mexico
• New York
• Pennsylvania
• Rhode Island
• Vermont
• Virginia
• Washington

SBM-FPs: State-based marketplaces that use the federal enrollment platform (HealthCare.gov)

• Arkansas
• Illinois (legislation enacted in 2023 called for the creation of an SBM-FP by 2025 and an SBM by 2026; CMS has confirmed that Illinois is no longer receiving federal Navigator funding as of the 2025 plan year,⁹ since the state began running an SBM-FP starting in November 2024. Illinois will have a fully state-run exchange by November 2025.)
• Oregon (Oregon plans to operate a state-run exchange platform starting in the fall of 2026, per legislation enacted in 2023)¹⁰

Partnership exchanges (these states use the federal HealthCare.gov enrollment platform, and are FFM states)

• Delaware
• Iowa
• Michigan
• New Hampshire
• West Virginia

Federally-run marketplace (these states rely entirely on HealthCare.gov and are FFM states)

• Alabama
• Alaska
• Arizona
• Florida
• Hawaii
• Indiana
• Kansas*
• Louisiana
• Mississippi
• Missouri
• Montana*
• Nebraska*
• North Carolina
• North Dakota
• Ohio*
• Oklahoma
• South Carolina
• South Dakota*
• Tennessee
• Texas
• Utah
• Wisconsin
• Wyoming

(States with an asterisk have a marketplace plan management exchange. Their exchanges are federally-run, but the state is active in certifying QHPs for sale in the exchange.)

For the 2015 plan year:

• Idaho used HealthCare.gov for enrollment in 2014, but switched to being a fully state-run exchange prior to the 2015 open enrollment period.
• Nevada and Oregon both had state-run exchanges in 2014, but due to technical difficulties, they both opted to become federally-supported state-based exchanges (SBM-FPs) before the 2015 open enrollment period (Nevada has since switched back to having a fully state-run exchange).

For the 2016 plan year:

• Hawaii opted to transition to an SBM-FP, abandoning its state-run enrollment platform (as noted below, Hawaii dropped the state-run aspect altogether the following year).

For the 2017 plan year:

• Arkansas switched from having a state-federal partnership exchange to an SBM-FP (enrollment continued to be via HealthCare.gov, so there was no change from a consumer perspective).
• Hawaii switched from an SBM-FP to the federally-run exchange (enrollment continued to be via HealthCare.gov, so there was no change from a consumer perspective).
• Kentucky switched from a state-based exchange to an SBM-FP (Kentucky switched back to a fully state-run exchange and the Kynect enrollment platform in the fall of 2021).

For the 2020 plan year:

Exchange management stayed unchanged for a few years. But several changes took effect in the fall of 2019, for the 2020 plan year:

• Nevada switched to a fully state-run exchange, after having an SBM-FP since 2015. Nevada enrollees now use Nevada Health Link instead of HealthCare.gov.
• New Jersey transitioned to an SBM-FP, after having a federally-run marketplace since 2014 (New Jersey switched to a fully state-run exchange in the fall of 2020, for coverage effective in 2021).
• Pennsylvania also transitioned to an SBM-FP, after having a fully federally-run marketplace in previous years. (Like New Jersey, Pennsylvania stopped using HealthCare.gov in the fall of 2020).

For the 2021 plan year:

The following changes occurred in the fall of 2020:

• Pennsylvania transitioned to a fully state-run exchange, called Pennie (residents no longer use HealthCare.gov).
• New Jersey transitioned to a fully state-run exchange, utilizing the GetCoveredNJ platform (residents no longer use HealthCare.gov).
• Virginia transitioned to an SBE-FP (Virginia transitioned to a fully state-run exchange with its own enrollment platform in the fall of 2023).
• Maine transitioned to an SBM-FP (Legislation was enacted in Maine in 2020 to move forward with the process of creating a state-run exchange, and Maine transitioned to a fully state-run exchange in the fall of 2021.)

For the 2022 plan year:

• New Mexico, Maine, and Kentucky transitioned away from HealthCare.gov as of November 1, 2021, for people enrolling in coverage with a 2022 effective date. All three states had used SBM-FPs for the 2021 plan year.

For the 2024 plan year:

• Virginia has a fully state-run exchange that became operational in the fall of 2023.

For the 2025 plan year:

• Georgia has a fully state-run exchange platform that became operational in November 2024.
• Illinois has an SBM-FP starting in November 2024 (and an SBM starting in November 2025). This change is due to legislation the state enacted in 2023.¹²

For the 2026 plan year:

• Illinois will have an SBM.¹²

Anticipated changes for future years:

• Oregon has an SBM-FP and plans to have a state-run exchange platform starting in the fall of 2026, for coverage effective in 2027 (under the terms of legislation enacted in 2023).¹³
• Mississippi enacted legislation in 2024 that authorizes the Insurance Commissioner to create a state-run exchange. But the legislation (HB1647) became law without the governor's signature.¹ Mississippi Insurance Commissioner Mike Chaney has long supported the idea of a state-run exchange,¹⁴ but he also clarified that he won't proceed without Governor Reeves's support.² 

Change to SHOP (small business) exchange management

Arkansas, Mississippi, and Utah previously ran their own SHOP exchange (the platform for small businesses to enroll in coverage), but switched to using the federal platform or a direct-to-carrier process by 2018. But by that point, even the federal platform for small business enrollment was no longer functioning as it had in past years, and small group enrollment had switched to a direct-to-carrier process in nearly every state. New Mexico was still running its own SHOP exchange platform as of early 2023, but switched to a direct-to-carrier system in mid-2023.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health insurance marketplace updates are regularly cited by media who cover health reform and by other health insurance experts.