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States and the Federal Government Working Together to Run Health Insurance Marketplaces

By Claire McAndrew,


States have three choices when establishing their health insurance marketplaces (also known as exchanges):

  • Run the marketplace on their own
  • Have the federal government run the marketplace
  • Work with the federal government to run a partnership marketplace

In partnership marketplaces, the federal government handles most functions, and states can choose to be in charge of either providing in-person consumer assistance or deciding which health plans the marketplace can sell.

State policy makers can use “Exchange Implementation: To Partner or Not to Partner?” to decide whether partnering is a good option. Use “State Responsibilities in a Partnership Exchange” to learn about the responsibilities for states that pursue this option.