State-by-State Health Insurance Exchange Activity

This map provides an overview of the most up-to-date state decisions regarding the structure of their health insurance marketplaces. A health insurance marketplace (also known as 'health insurance exchanges') is a venue where individuals and small employers can shop for insurance coverage. According to the federal government, marketplaces must be set up by Oct. 1, 2013 for policies to take effect in Jan. 2014. The exchanges will also direct people to Medicaid, the government health insurance program for the poor, if they're eligible. States have the option of setting up their own exchanges, partnering with the federal government to run an exchange, or opting out. In that case, the federal government will run the exchanges for their residents.

Initially, exchanges will be open to individuals buying their own coverage and employees of firms with 100 or fewer workers (50 or fewer in some states). Most Americans will continue to get insurance through their jobs, not via the exchanges. Most will be people who are eligible for subsidies, which will average an estimated $4,600 per person in 2014. Undocumented immigrants will be barred from buying insurance on the exchanges. Consumers will also be able to 'shop and compare' policies sold by different companies and plan benefits will be standardized in an effort to make it easier to compare cost and quality. Plans will be divided into four different types, based on the level of benefits: bronze, silver, gold and platinum. The exchanges are also required to operate toll-free hotlines to help consumers choose a plan, determine eligibility for federal subsidies or Medicaid, rate plans based on quality and price and conduct outreach and education.

Plans will have to offer a set of "essential benefits." Those details were finalized in February 2013, andi include benefits such as prevention, wellness, chronic care management, hospital, emergency, maternity, pediatric, drug, lab services and other care.