State-Based Marketplaces Offer Greater Control and Cost-Savings

State-based marketplaces offer a more controlled and cost-effective approach to healthcare and benefits administration.

By leveraging a state-based marketplace, employers can gain greater control over their benefits offerings, allowing them to tailor their plans to meet the specific needs of their workforce.

This level of customization can lead to significant cost savings, as employers can avoid one-size-fits-all plans that may not be the best fit for their employees.

In fact, some studies have shown that state-based marketplaces can result in cost savings of up to 20% for employers.

A marketplace is a platform where individuals can purchase health insurance plans that are subsidized by the Affordable Care Act (ACA).

Each state had to decide whether to create its own state-run health insurance exchange or offer enrollment through a federally-operated exchange when the ACA was passed in 2010.

GetInsured is the leader in State-Based Marketplace technology, providing assistance to states since the inception of the ACA.

A state-based marketplace (SBM) is a health insurance exchange that's independently orchestrated by a state's government.

These exchanges offer plans that are supported in a specific state and available for purchase.

States that haven't established their own exchange will participate in the Federally Facilitated Marketplace (FFM), aka the federal exchange.

States implement their own marketplace to have more control over the enrollment process, marketing campaigns, and enrollment deadlines. This allows them to tailor their approach to best serve their residents.

State marketplaces have taken the reins into their own hands to make health insurance enrollment both profitable and sustainable. They have more control over outreach efforts and enrollment flexibility.

Having more control helps create more balanced risk pools that encourage insurers to stay in the market with better rates than residents would find on the Federally Facilitated Marketplace (FFM). This results in a more stable and sustainable marketplace.

States that implement their own marketplace can now take advantage of mature solutions that keep costs down and operations nearly flawless. This is a result of the market and individual state needs changing since the launch of the ACA.

By implementing their own marketplace, states can set up and operate the marketplace quicker, better, and for a fraction of the cost compared to building one from scratch. This is thanks to technology providers like GetInsured.

GetInsured offers an "all-in-one" solution for states, meeting their needs for an operationally efficient migration from a Federally Facilitated Marketplace (FFM) to a State-Based Marketplace (SBM).

Their technology platform is mature and has been used in whole or in part by five state-based marketplaces successfully.

GetInsured has been running call centers for over ten years, providing a proven and fully built-out operational call center with dedicated resources for their customers.

Their implementation approach leverages best practices from previous marketplace implementations and does not require extensive customization or a ground-up system build.

Here are the key benefits of GetInsured's solutions:

GetInsured can set up and operate the marketplace quicker, better, and for a fraction of the cost compared to building a state-based exchange from scratch.

State-Based Marketplaces offer a range of benefits that make them more user-friendly and effective than the Federal Marketplace.

States have more control over the enrollment process, marketing campaigns, and enrollment deadlines, allowing them to tailor their approach to their residents' needs.

This control has proven effective in creating more balanced risk pools, encouraging insurers to stay in the market with better rates.

State-Based Marketplaces also eliminate the auto-renewal risk present with Healthcare.gov, providing a more reliable experience for users.

Here are some of the key benefits of State-Based Marketplaces:

By taking a more hands-on approach, states can create a more streamlined and effective enrollment process that meets the unique needs of their residents.

There are two types of state-based marketplace platforms: SBM (State-Based Marketplace) and SBM-FP (State-Based Marketplace-Federal Platform). SBM is a health insurance exchange that's independently orchestrated by a state's government, offering plans that are supported in a specific state and available for purchase.

Some states, such as California, Colorado, and Massachusetts, have their own SBM platforms. These states have taken the initiative to create their own exchanges, which allows them to have more control over the plans and services offered to their residents.

States that participate in SBM-FP rely on the federal exchange for eligibility and enrollment functions, but still have control over the usual business for an individual marketplace. This means that clients in SBM-FP states enroll in coverage through HealthCare.gov.

There are currently several states participating in SBM-FP exchanges. Some of these states include Colorado, Idaho, and Nevada. These states have chosen to partner with the federal government to handle the eligibility and enrollment functions, while still maintaining control over their own exchanges.

Here are some examples of SBM platforms:

It's worth noting that the process of enrolling a client in one SBM may vary from enrolling them in another SBM or the federal exchange. Therefore, it's essential to follow the instructions on the state's platform to ensure a smooth enrollment process.

GetInsured offers a complete end-to-end solution for states that have opted to create their own health insurance marketplaces. This includes Consumer Decision Support Tool, Plan Management, Enrollment Reconciliation, Call Compliance, SEP Verification, and Consumer, Agency, Broker and Insurer Portals.

Their solution provides an "all-in-one" experience, meeting a state's needs for an operationally efficient migration from a Federally Facilitated Marketplace (FFM) to a State-Based Marketplace (SBM). This includes user-friendly tools and solutions for consumers, agents, customer service representatives, and administrative users.

GetInsured has successfully transitioned a state from the FFM to an SBM, leveraging best practices from previous implementations. They also offer a small implementation footprint, which means less customization and a faster implementation process.

Their technology platform is mature and has been used in whole or in part by five state-based marketplaces successfully. This includes Idaho, Washington, Minnesota, Nevada, and New Jersey.

Here are the states currently working with GetInsured:

State-based marketplaces operate independently, with each state's government orchestrating its own exchange. These exchanges offer plans that are specific to that state and available for purchase.

If a state doesn't have its own exchange, it will participate in the Federally Facilitated Marketplace, also known as the federal exchange.

Georgia has its own state-based marketplace, which means residents can enroll in health insurance plans that are specifically designed for their state. These plans are supported and offered through Georgia Access.

If you live in Georgia, you can purchase health insurance plans through Georgia Access, which is a great option for those who want more control over their healthcare choices.

If you're working with clients in states with State-Based Marketplaces (SBMs), you'll need to enroll them through the state's platform.

Some states have their own platforms, which can be found here: Connect for Health ColoradoGeorgia AccessKentucky Health Benefit ExchangeMaryland Health ConnectionGetCoveredNJNY State of HealthPennieVirginia’s Insurance Marketplace

The process of enrolling a client in one SBM may vary from enrolling them in another SBM or the federal exchange. It's a good idea to take your time and follow the instructions on the state’s platform.

Selling ACA plans is a great opportunity to reach new customers and expand your business.

The Open Enrollment Period (OEP) runs from November 1 to January 15 in most states. Some states, however, set their own OEP dates.

Indiana starts open enrollment on October 15, which is earlier than the typical November 1 start date. California, D.C., Idaho, Massachusetts, New Jersey, New York, and Rhode Island end open enrollment on January 31, which is later than the typical January 15 end date.

Generally, clients who enroll before December 15 will have a January 1 effective date. This is because most states allow for a January 1 start date for applications submitted by December 15.

However, some states have different rules. For example, Maryland and New Jersey are exceptions. In Maryland, coverage starts January 1 for applications submitted by December 31, but coverage starts on February 1 for applications submitted the first two weeks of January.

Similarly, in New Jersey, coverage starts January 1 for applications submitted by December 31, but coverage starts on February 1 for applications submitted between January 1 and January 31.

If you miss the OEP, you can only enroll in coverage by being eligible for a Special Enrollment Period (SEP). In these cases, coverage is effective the first of the month after the application is submitted.

Here are the specific effective dates for each state:

Remember, coverage won't be effectuated until the binder payment is made, which is typically the first month's premium due 30 days after enrollment.

Eleven states and the District of Columbia currently operate their own health insurance marketplace eligibility and enrollment websites under the Affordable Care Act (ACA).

Several states are contemplating a transition from the federally-facilitated marketplace (FFM) to a state-based marketplace (SBM).

The number of states operating their own health insurance marketplaces is slated to grow.

Researchers reviewed states that have publicly declared intention or interest in transitioning to assess decision-making regarding the benefits and risks of switching platforms.

The primary factors driving states to switch from the HealthCare.gov platform to a full SBM are unclear, but it's likely due to the desire for more control over their health insurance marketplaces.

Agent training and requirements are crucial to selling under-65 plans in state-based marketplaces (SBMs). Agents must complete training through each exchange's platform, and requirements vary by state.

Maryland has specific training requirements, where agents must apply and complete initial training to receive authorization to sell. Broker authorization expires after two years, and the exchange will send a renewal notice 60 days prior to expiration.

New Jersey requires agents to complete the Broker Intent to Sell form first, and annual certification is also necessary. On the other hand, New York doesn't require annual certification, but agents must certify every two years from their initial certification date.

Agents selling ACA products in Federally Facilitated Marketplace (FFM) states must complete FFM training through HealthCare.gov or HealthSherpa. This ensures they're up-to-date on the latest products and requirements.

Here's a quick rundown of the training requirements for each state mentioned:

No information providedNew YorkNoNoCertify every 2 years from initial certification date

By understanding these training requirements, agents can ensure they're compliant and ready to sell under-65 plans in SBMs.

In the US, health insurance exchanges are either state-based or federally facilitated. States that have their own exchange are called State-Based Marketplaces (SBM). These exchanges offer plans that are supported in a specific state and available for purchase.

If a state doesn't have its own exchange, it will participate in the Federally Facilitated Marketplace (FFM). Clients who enroll in a marketplace plan in these states enroll in coverage through HealthCare.gov or an approved Enhanced Direct Enrollment (EDE) site.

Some states take a hybrid approach and are referred to as State-Based Marketplace-Federal Platforms (SBM-FP). In these states, the state is responsible for conducting all usual business for an individual marketplace, but relies on the federal exchange for eligibility and enrollment functions.

Clients in SBM-FP states enroll in coverage through HealthCare.gov. The states participating in SBM and SBM-FP exchanges can be noted on a map.

Transitioning to a state-based marketplace (SBM) is a significant undertaking that requires careful planning and consideration. States looking to make this transition need to know their specific goals, as it's a natural next step in making health care more affordable.

Setting realistic expectations is crucial, as this transition is no small feat. It's essential to understand that transitioning to an SBM comes with several risks.

Allowing for sufficient lead-time is also vital, as it will give stakeholders ample opportunity to prepare and adapt to the changes. Early and frequent engagement with stakeholders is also necessary to ensure a smooth transition.

By taking these steps, states can make the transition to an SBM a success and continue to work towards reducing the number of uninsured individuals.