Find out how to leverage the ACA Marketplace and maximize your budget
Individual states are in charge of their own health insurance marketplaces. The way that Pennsylvania manages a health insurance exchange might be similar to Ohio but different from Georgia, Texas, or Indiana. If you run a business with locations in different states, or if you’re a broker with regional scope, it’s good to know how to navigate the state of health insurance in your area and how an HRA can help you maximize your budget and employee happiness.
Who should read this article
If you’re curious about health insurance in different states, we’ve done the research for you
- This article is particularly helpful for:
- Employers with locations or employees in different states
- Employers who are thinking about expanding their business in other states
- Brokers who cover a multi-state area
ICHRA classes for multi-state employers
HRA refresher
A quick overview of HRAs: A health reimbursement arrangement is a tax-free way for employers to reimburse employees for health insurance premiums and qualified medical expenses.
When an employer offers an HRA, they designate a monthly allowance for employees to buy their own health insurance plan from the ACA Marketplace.
Businesses tend to love HRAs because they provide cost controls and budget predictability while giving employees freedom in choosing their own plan.
Want to learn more about HRAs?
Which states benefit most from HRAs
Colorado, Georgia, Indiana, Maine, Maryland, Ohio, Pennsylvania, South Carolina, and Texas are our top recommendations for an HRA
With an HRA, employees buy their health insurance plans through the Marketplace. That means local markets make a big difference to employees and influences the allowance the employer gives. So where are the best places to leverage the benefits of an HRA?
The first factor is pricing. If monthly health insurance premiums are less expensive in a state’s individual market than they are in the small group market, it's a good place to leverage an HRA because an employee’s monthly payment will be lower so the employer may choose a smaller allowance while still providing the support employees need.
The second factor is employee experience. If the state’s health insurance exchange provides a broad range of carrier and health plan options with strong networks, that's a good sign for HRAs. It means that employees are likely to find the providers they want and easily get the healthcare they need.
The top states that meet this criteria are Colorado, Georgia, Indiana, Maine, Maryland, Ohio, Pennsylvania, South Carolina, and Texas. They are our recommendations for an HRA because they have vibrant marketplaces and relatively affordable health insurance.
State health insurance marketplaces
There are different ways a state can facilitate a health insurance Marketplace
States have three options when it comes to Marketplace health insurance. They can run their own exchange, use the federal Marketplace, or a hybrid model of a state-run plan that utilizes the federal Marketplace platform.
Of our highlighted states, Colorado, Georgia, Maine, Maryland, and Pennsylvania have their own health insurance exchanges; Indiana, Ohio, South Carolina, and Texas use the federally facilitated Marketplace (ACA health insurance).
Why do insurance prices vary by state?
The average cost of health insurance varies by state
Here are a few influential factors.
Market competition: States with more insurers generally see lower premiums, while areas with monopolies or fewer choices face higher rates.
Access to healthcare: Premiums tend to be higher where healthcare providers are scarce and lower where providers are more easily accessible.
State regulations: Some states (including Colorado and Maryland) offer income-based subsidies on top of federal adjustments.
Demographics: Premiums can be set based on anticipated populations and whether they are healthy or have more medical needs.
Regional considerations for health insurance plans
Northeast: Georgia, Maine, Maryland, Pennsylvania, and South Carolina
- Higher premiums: States in the Northeast typically have higher premiums than other U.S. regions for both single and family coverage.
- Comprehensive mandates: This area has more comprehensive healthcare mandates, requiring insurers to cover specific benefits.
- Urban costs: There is a high concentration of large urban areas where the cost of living and demand for healthcare services tend to be high.
Midwest: Indiana, Ohio
- Average premiums: The Midwest generally falls in the middle range for health insurance premiums.
- Geographic variations: While overall premiums are more moderate, there can be cost variations within the region and within states.
- Development type: The mix of urban and rural areas means varying insurance options and access to providers.
South/Central: Colorado, Texas
- Lower premiums: States in the central and southern U.S. have some of the lowest average premiums in the nation.
- Cost factors: Premiums are impacted by lower costs of living as well as provider practice patterns (e.g., lab and appointment frequency).
- Medicaid expansion status: In some south/central states, the lack of Medicaid expansion can influence the insurance marketplace dynamics and risk pools.
Small business health insurance
Of our recommended states for HRAs, Georgia, Ohio, Pennsylvania, and Texas have the most small businesses
Most small business owners would love to offer health insurance, but it seems too expensive and complicated. Enter QSEHRA: It’s an HRA for small businesses, and it’s a game changer. In addition to leveraging QSEHRA to recruit top talent and retain great employees, employers can also take advantage of the state-based small business health care tax credit.
QSEHRA is designed for employers with fewer than 50 employees. It has the same, simple process of all HRAs. You determine an allowance, employees buy their individual plan (with our support), and you reimburse for premiums and qualified medical expenses (also with our support!)
Of our recommended states for HRAs, Georgia, Ohio, Pennsylvania, and Texas have the most small businesses in the U.S. and are particularly well suited for QSEHRA.
Transform your small business with an HRA
Why HRAs are a strategic move for health insurance
Let a Take Command HRA put you in a great state of mind
If you’re looking for the best health insurance option, consider an HRA. We’re confident that you’ll love it (and we have 7,000+ clients as proof.)
HR professionals can leverage a Take Command HRA for recruitment and retention. CFOs can rely on them for accurate forecasting. And brokers can offer them as a smart alternative to group health insurance.
A Take Command HRA works for small businesses, mid-level markets, and enterprises, so no matter the size of your business, we’ve got you covered.
Reasons to love HRAs:
→ Budget control
→ Predictable costs
→ Consistent coverage across state lines
→ Personalized plan choices for employees
→ No employer responsibility for health risks
→ Flexible employee classes
→ Only with Take Command: In-house support team
A Take Command HRA is easy as 1, 2, 3 |
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1 Craft a benefits plan tailored to your team. Our HRA solutions provide customized benefits that meet your team’s needs. |
2 Enjoy effortless onboarding. We manage the entire transition, ensuring a smooth shift for everyone involved. |
3 Streamline employee health benefits. Our platform makes managing health benefits easy with simple reporting and clear instructions. |
Contact Take Command to learn about HRAs
Keep reading
→ The Take Command HRA Hub: Purpose built for people
→ Be an HR hero: Deliver savings to the C-suite & choice to your employees
→ Is it time to ditch that group health plan?
Let's talk through your HRA questions
Our HRA management solutions help companies of all sizes reimburse employees for health insurance, giving employees choice over what works best for them and promoting health and wellness within an organization. We offer ICHRA and QSEHRA administration software designed to be simple, effective, and empowering. Take Command is trusted by 7,000+ leading organizations and the only HRA administrator with in-house enrollment support.
