Why Health Insurance Is Different in Every State

Why Your Health Insurance Options Depend on Where You Live

The health insurance options available to you can look different across state lines. Why does where you live matter—and how does government involvement shape the plans you can choose?

In this episode, Matt Allen and Aaron Miller explore the relationship between government, insurance regulation, and consumer choice. They share their perspective as brokers on state insurance rules, ACA marketplaces, and the challenges of helping individuals compare coverage across different states.

You’ll learn about:

The role state departments of insurance play in regulating available products.
The differences between federally facilitated and state-based ACA marketplaces.
How licensing, training, and marketplace requirements affect brokers’ work.
Why non-marketplace coverage options vary by state.
How health needs, income, doctors, and prescriptions shape a coverage comparison.
The hosts’ views on Medicare for All and the trade-offs of expanding government involvement.

We also discuss why Matt starts coverage comparisons with the ACA marketplace, when he considers alternatives, and why he believes consumers benefit from understanding the advantages and limitations of each option.

The central takeaway: understand the choices available where you live. Comparing coverage based on your own circumstances—and knowing the trade-offs behind each option—can help you navigate the health insurance system with greater confidence.

About the hosts

Matt Allen brings over a decade of experience helping early retirees bridge the health insurance gap to Medicare. Together with Aaron Miller, he helps make the options and trade-offs easier to understand through Plan Shaman.

Planning to retire before 65?

Plan Shaman provides free health insurance education for individuals and couples preparing for early retirement. Explore your options so you can make a confident decision when the time is right.

Created 10/09/2026

Why Health Insurance Is Different in Every State Transcript

Matt Allen (00:05)
Welcome back to another episode of Talking Shit. Shit, of course, is an acronym for straight health insurance talk. I am Matt Allen, joined as always by Aaron Miller.

Aaron (00:15)
Sunny in seventy five today.

Matt Allen (00:18)
It's a little toastier here in Memphis. Definitely sunny.

Aaron (00:21)
yeah?

Matt Allen (00:23)
yeah. We're getting in the eighties. It's like seventy five at seven AM when I step out the door in the morning. So awesome.

Aaron (00:30)
Feel like you're just walking

through some thick fog, thick, thick air.

Matt Allen (00:35)
It was great. I I actually love it. a lot of people complain about it, but man, you know what to expect here.

Aaron (00:44)
Fair enough.

Matt Allen (00:45)
Reliable.

all right, what are we talking about today?

Aaron (00:51)
Well, today I want to talk about government in health insurance. You know, insurance on a lot of a lot of other types of insurance are specifically run in the private markets. You think about auto insurance, homeowners insurance, but for many reasons, the government is heavily involved in health insurance. And you know, we can touch on Medicare, Medicaid, state-run marketplaces.

federally run marketplaces. but I think the big thing I want to start off with is kind of just the state by state nature of health insurance and why state governments not only have a say in it, but what they're saying. So I guess let's start there.

Matt Allen (01:40)
So

there's a federally enacted department of insurance, and then there are state by state departments of insurance. And the reason that a health insurance policy created in Indiana and passed through the Department

Of insurance in the state of Indiana can't be then sold in California, is actually a measure the government put in place decades ago for consumer protection and for the company's protection. That some company in New York couldn't just take over the entire health insurance market because they created a a product. That was kind of the idea behind it, and it was for protection's sake, and it never really went away. And so when we talk about

The federally facilitated marketplace or Medicaid, Medicare, VA coverage, Tricare, Peace Corps, all these different things. There are absolutely federal mandates within them, and some of those programs I mentioned are federally funded, but each state still gets to dictate more or less which products are allowed to be sold.

to the public, which ones can be client facing. So whether this is a small group, large group health insurance plan, whether it's an individual plan, whether it's something as innocuous as dental envision, if somebody lives in Wisconsin and they want to buy health insurance, I as an agent have to be licensed in Wisconsin.

And appointed with a health insurance carrier who has a product in Wisconsin that's been approved by the Department of Insurance for Wisconsin, or I can't sell it them. So there's a lot of governmental steps. I make it sound a lot more confusing potentially and and that there are a lot more hurdles involved, but each state is there to give their stamp of approval. So in more heavily governmentally regulated states.

Such as those on the West Coast or those in New England, there's a much more restricted market for what's available for health insurance. And it is primarily due to consumer protection. That's the idea behind it. But when you put a stranglehold on the products that can be made available by insurance companies for the general population.

And you're requiring the government to basically sign off on it, it's a very slow moving endeavor. It's never going to be cutting edge. And with the pace of the economy now, the pace of technology, these more heavily regulated states, f as at least as far as insurance are concerned, are completely leaving the consumers in the dust.

There are so many more

Aaron (04:40)
Yeah.

Matt Allen (04:40)
options in a state like Indiana or Tennessee or Florida or Texas than there ever will be in New York or California, simply due to the sm slow moving nature of government and how their individual departments of insurance are so restrictive.

Aaron (05:00)
Yeah. And so we see in the ACA marketplace, there's a divide, right? So we have the federally facilitated marketplace, which each state, correct me if I'm wrong, is able to opt into, right? If they want to be in that system. And if they opt out of it, they have a state run marketplace. And so from our perspective as brokers, the federally facilitated marketplace just creates a more

just congruent system for us to work within, right? And the companies are, I mean, somewhat consistent across state lines, right? It does change, but

Matt Allen (05:41)
Swan.

Aaron (05:42)
as brokers we're able to help people more easily in those states with the federally facilitated marketplaces and get contracted with those companies who are then on that marketplace. So I I guess let let's take a few examples, let's say Georgia.

Right, Georgia's on a state-based marketplace, but for some reason their marketplace is more friendly than let's say New York state marketplace. What what's going on there and why are there so many different tiers to, I guess, usability from a broker standpoint?

Matt Allen (06:18)
From a broker standpoint, well, if there's a state run marketplace, you not only need to be federally facilitated, trained, so you need the federal, but then you also need the individual state course that they require you to take. And when it's a state run marketplace, you're not using healthcare.gov or any of the ancillary ones where you can shop

all of the other states that utilize the federally facilitated marketplace. You've got to go to the individual states website and marketplace. And once again, it's just the government exerting more control

over what's available and how they want people to access the state marketplace. It is another barrier to entry for brokers because now they have to spend additional time learning the intricacies of these individual state marketplaces. And like if you take Colorado for example, we aren't licensed in New York. We don't want to do business there. The commissions are terrible. They've made it very difficult for

anyone to run a profitable brokerage there. I actually don't know any brokers that work in New York, which is making people once again rely more on the government to help hold their hand through the whole situation. So now these people aren't getting unsolicited they they aren't getting solicited advice from a broker who doesn't have a dog in the fight. They have to go to the marketplace and talk to someone who only contracts with the marketplace, who is paid

by the marketplace and guess what they're going to show them? A marketplace plan.

States like Colorado that are becoming more liberal by the day, they have a f it's a forty hour course in order for me to get license to sell in the state. That's a longer course than the federal course. Just and I gotta do it every single year. So we no longer deal with ACA marketplace plans in Colorado because it's not worth the time to get license there to use their inefficient website. So a lot of these websites are now created by their state.

Governments instead of just relying on the healthcare.gov that's been around for 17 years that all these other states are utilizing, it's it's just adding another barrier to entry. And what this all really boils down to, the more government gets involved in healthcare and health insurance and these state exchanges and these federal exchanges, the more they get involved.

The more the consumer is reliant upon the government for assistance in finding the plan, and it's creating this, you know, codependency between the consumer and the marketplace and the government, where basically the government doesn't trust you to make a good decision on your own. Is what it it's kind of boiling down to. They're dictating which

Aaron (09:12)
Hm. I see. Yeah.

Matt Allen (09:15)
germs products you can buy.

Because they don't think you are capable enough to figure it out. And in a lot of people's situation, maybe they don't want to have to figure it out on their own. Or maybe they are incapable of figuring out the best one. We've talked to hundreds of people that just want the cheapest thing possible and then they complain when it doesn't cover the things that they want. So maybe the government's onto something for a lot of people. But we believe in empowering people to confidently navigate the healthcare system. That's the mission. That's the goal.

And so by by confining people into these government-run marketplaces,

these state run marketplaces in a state like New York, slashing commissions to the bone. So now a broker who the entire job of a broker is to be a fiduciary to the client to show them everything that's in their best interest. Now I I don't even want to get licensed in New York to help that person shop because I don't get paid enough to do it. So now I don't work there. No brokers work there. So now they are relegated to use the government system and they're gonna get on a government

Aaron (10:31)
Yeah. And you know, we've talked about private options in past podcasts. And these private options you won't find them on state run marketplaces, you won't find them on federally facilitated marketplaces. But the plans, you know, that these private companies are coming out with, they're not, you know, kind of on a hard line, you know, we're only gonna work with federally facilitated states, right? They kind of

you'll work with the Department of Insurance and depending on the state they can get in or not. So the private plans we work with they're in what, thirty one, thirty two states, is that right?

Matt Allen (11:09)
for one of our carriers, yeah.

Aaron (11:11)
for one of our carriers. And so I I guess why are these like I I feel like I hear of new states on the on the precipice of allowing them in. What do you think's going on there and what is kind of the driving factor of whether these departments of insurance allow new products in or not?

Matt Allen (11:32)
It just all comes down to money and governmental control. Unfortunately we have a bipartisan system in this country where more tribal leanings left, right, blue, red determine outcomes as opposed to common sense, which is very frustrating.

And so instead of these departments of insurance allowing a lot of options for the consumer, they are allowing the options that align with their political ideologies.

So when you are seeing a bluer state switch to a state-run marketplace and not allowing non-marketplace health insurance products to be brought to market, it's because of a political ideology that the government knows what's best when it comes to health care and when it comes to health insurance. And if you allow these private health insurance companies into our state to sell to our consumers, not only

Is this going to draw a bunch of people from the state run government mandated health insurance? It'll pull people from that over to these private plans, but they are essentially saying our residents aren't smart enough to know a good product from a bad product. So we're just going to all funnel everybody into the state run plans, and that's just going to be what we're going to allow.

These ones are too risky for other people. When you actually look at these marketplace plans in these state-run places, they're some of the most expensive and the most restrictive policies out there. You get people in New York City shopping HMOs for a thousand dollars a month per person and they can't even take it into New Jersey. It's absolutely asinine. Whereas if a private plan were allowed to come in there, they could undercut the marketplace premiums.

They could undercut the deductibles, they could open up the networks, and the state of New York, quite frankly, doesn't want that for their residents, because that is an alternative to the Affordable Care Act that they're propping up and that they're trying to just keep going again because of a political ideology.

Aaron (13:58)
Got it. Got it. so you've been doing this for a decade, over a decade.

Matt Allen (14:05)
Mm-hmm.

Aaron (14:06)
Have you seen, you know, kind of the tide moving one way or the other, or is it stayed pretty consistent as far as you know how open some of these states are? Is it getting more open?

Matt Allen (14:21)
I don't really know if it's getting more open or more closed off, but and I and I need to go back and make sure everyone understands half of my clients are on the Affordable Care Act. I want the Affordable Care Act to exist.

I want it to be in all 50 states. I want the people who need the coverage through the Affordable Care Act to get it. And that's the first thing we show every single person that we talk to about health insurance. We go straight to the marketplace, we optimize it for their prescriptions, their doctors, their hospitals, their income, their zip code, their household size, and we show them all the different options. And we say, okay, here is this.

But if they also happen to be in a state where non-marketplace options are available and it's a good fit.

Which is not a good fit for everybody, but where it's a good fit, we will also show them those. And then then we will stack them up side by side and say, here's your marketplace option, here's your non-marketplace, here's the pros and cons of this, here's the pros and cons of that. What do you think? And we'll make a recommendation. We've got over a thousand case studies of different people in different situations across the country. So I'm I've got a lot of data there and a lot of anecdotal evidence to give those recommendations. So please don't think I don't.

Like the ACA. What I don't like is when a state says, here's the only option you have, and they restrict your optionality because they're basically saying, you don't know a good product if you saw it, let us decide that for you. And my job as a broker is to show you all the options, show you all the pros and all the cons of every option. Everything's got a drawback.

All of life is just trade-offs. And so if you want a marketplace plan, great, you'll get this, but you'll give up that. You want a non-marketplace, great, you'll get this, but you'll give up that. It's about fitting the right product to the right situation. And when you're in one of these states like New York, we don't have options. There's not options.

They might give you the illusion of options, but it's all state-run, state-based marketplace plans when it comes to individuals. So it's very restrictive. So as far as do I see the tide shifting, I see a lot of companies, insurance companies, coming up with new products to try to solve this problem. Because the ACA is so

bloated now. If you don't receive a tax credit on the ACA anymore, it's now become the Unaffordable Care Act as opposed to the Affordable Care Act. It's this little tongue in cheek, stupid pun that we say, but it's absolutely correct. West f take West Virginia, for example. If you you're a family of three in Charleston and you don't get a tax credit, your cheapest ACA plan is three thousand dollars a month. It's thirty six thousand dollars a year if you're

A family of three and you make 110 grand a year. Now in West Virginia, maybe that's a lot of money. But it's certainly not like the end all be all. $36,000 a year in premiums off $110,000 income. That's what? 30% of

Aaron (17:35)
Yeah.

Matt Allen (17:35)
your income? That's ridiculous. Thankfully.

West Virginia's Department of Insurance has allowed non-marketplace plans to be sold there as well. So now if I come across a family in West Virginia who's paying full price for an ACA plan, meaning paying $3,000 a month at least, I can then go over here and show them something for twelve hundred a month. Be like, hey, this might be better. But that same situation if the Department of Insurance go to Virginia.

As opposed to West Virginia. Virginia doesn't allow these non marketplace alternatives. So you're stuck where Virginia says you can go. And their Department of Insurance has has dug their heels in and said we're not going to allow these non marketplace. They aren't suitable for our residents. And who are they to determine that? They are supposedly out for to protect the consumer, but if the consumer is properly educated about the pros and cons of the non marketplace, let them decide.

Let them pick and choose. And so I'm not necessarily seeing individual states become more lenient or less lenient. I'm seeing the majority of states just dig their heels in on what they once said, and then that's just how it's gonna be. A lot of these states

Aaron (18:48)
Yeah.

Matt Allen (18:48)
are going down with the ship. They're going down with the ACA ship, which is becoming more and more bloated. Please don't get me wrong, I love the ACA. When it makes sense for the person, we're gonna sign you up for it.

But let's get some optionality in there. Let's get some alternative solutions. And that's why we are licensed in the states we are licensed in because they have optionality.

Aaron (19:11)
Yeah, so if you're out there in one of these state run marketplace states, get that second home in in Florida. Get it in Texas, you know?

Matt Allen (19:21)
I mean, you really just need a mailing address in order to sign up for a plan in another state. I'd much prefer just be your permanent address, permanent residence. but there is some optionality there. Some of these states with state-run marketplaces, they do have options. Georgia has options, Illinois has options, Nevada has options. Those are all state-run marketplaces. So it's not just an end-all-be-all if you do have a state-run marketplace. But

The majority of states they don't want to bring alternatives to the ACA to market. They just simply don't. And whether that's, you know, ideologically good or bad, that's up to the individual to decide. From a broker's standpoint, the amount of clients who I've seen who would qualify medically for a non marketplace plan and save hundreds of dollars a month, but they simply ring it live in the wrong state, I think that's crazy.

I don't think that that is right and I think that they should be allowed a different option to the Affordable Care Act, if it makes sense for them.

Aaron (20:32)
Yeah. No, absolutely. another thing I want to bring up, just in terms of government in health insurance. You know, the government, the federal government, runs Medicare. Right? Medicare is great for the people who currently qualify for it. And I've been seeing, you know, it's been a I feel like a motion for a while now, this Medicare for all movement. And

I I know it's a whole can of worms, but what would that look like? Is it feasible at all? Should government just say, let's let's lock it all down, let's get everybody on Medicare and just, you know, solve this problem once and for all?

Matt Allen (21:20)
in a utopia that

Aaron (21:23)
Ha ha.

Matt Allen (21:24)
that works and that's that sounds great it really does if overnight you snapped your fingers and said Medicare for all a lot of people would be helped better than they are right now and a lot of people would be hurt worse than they're being hurt right now

There's so many arguments on both sides of that and I have a very strong argument, against it, because I know the

Intricacies of navigating the health care industry. I understand it because I've been on this side of it for over a decade. I've helped people navigate surgeries, hospitalizations, disease management, prescription care, imaging, blood work, lab work, doctor visits, chiropractor, health insurance, deductibles, networks, retiring, Cobra, Medicare, Medicaid, Tri-Care, VA, Peace. I've I've helped people nearly every situation.

And the one repeat offender to making things more difficult for people is anything governmentally regulated, anything governmentally mandated is making it more difficult. There's more hoops to jump through. It's a worse fit overall. The

Worst way you could solve a health insurance crisis in a healthcare crisis is by saying we're gonna give everybody the same thing. That doesn't make any sense to me. I've met thousands of people, and outside of like a super healthy 26-year-old coming off their parents' plan, rarely have I ever seen two situations that were the same situation, health-wise.

There's always nuance. There's always intricacies. There's travel plans. There's prescriptions. There's mixed families. There's getting a job. There's temporary care. There's cobra. There's getting onto Medicare. There's Medicare disability. There's Medicaid. There's income qualifications. There's splitting time. There's divorces. There's child support issues. And there's who's claiming which kid. There's so much intricacy. For you to just say, we're going to give everybody the same thing and it's going to work out perfect is absolutely

It makes no sense. And it takes once again the power of the individual away from them and puts it into the hands of the government. And if anyone has been paying attention to the government, I've been around 40 years, I don't want them having more responsibility. I don't want the government dictating more things for us.

If they can prove that they are relatively capable of doing the things they've already been given to do, maybe we can start talking about Medicare for all and Medicare for seniors and for people disabled. It's been a resounding success overall. But it is an unfunded liability on the balance sheet of the federal government.

So while people save money and get better care overall, once they reach sixty five and get on to Medicare as long as they get the right supplement, right drug plan and all of that.

The federal government orchestrating that, they're losing billions of dollars per year on that. This this is a success on the consumer side. If they stay away from a Medicare Advantage plan, it is a resounding failure on financing it.

Aaron (25:26)
Yeah.

Matt Allen (25:27)
Medicare will likely not be there by the time I get there, or it will look very different. And so wanting to expand that system.

to every single person as it stands today will be an administrative and bureaucratic nightmare not to mention the millions of jobs lost

Through the insurance industry, and maybe some people are like, Good, get those get those

Aaron (25:54)
Yeah.

Matt Allen (25:55)
creedons out of here. And maybe they don't want they don't even think my job should exist. And that's totally fine. I would I would be able to transition and help people navigate Medicare for all. I'd get a consulting position. I'd I don't care. If that's what happens, that's what happens. I will still my mission will still stand to help people empower people to confidently navigate the healthcare system. So if it totally changes overnight, I'm gonna learn everything there is about it and I'm gonna empower people.

But to think that that's just the solution I think is short sighted. And for the sake of my fellow countrymen and women, I hope it doesn't happen.

Aaron (26:40)
All right. I I agree. I mean, to think that you can just take, you know, the kind of wound system that we have and just say, you know what? Just you guys can call it a day, call it a year. Just put it on the shelf. It's it's done. Everyone gets Medicare. I mean that

Matt Allen (26:59)
Now

Aaron (26:59)
just feels not just problematic but improbable.

Matt Allen (27:05)
It it it's very improbable. I don't think that it's going to happen any time soon. but a lot of people are clamoring for it.

And b it could happen. A lot of people point to other countries having success with their national healthcare initiatives and cite their, you know, cost per resident as much lower and the cost of care is much lower and the overall care is much better and much higher and you know, if those stats are true, I I can see the argument. I can absolutely see the argument. I think the United States is a much larger population overall and

it's kind of this chicken and the egg thing. You know, a lot of people point to Europeans having better health overall than Americans, and they have national health care. and so the argument is that that leads to them being healthier. I think a converse argument could be made that because Europeans are healthier, the national health care system has less of a burden, is

cheaper to fund and to prop up and it's also been in place since the inception of the countries, so it isn't this overhaul of the system. I think you can make that argument where America, I mean seventy percent of people are overweight or obese. Right now right now, Americans have to pay for their health care, right? That's that's the big issue, high cost of health care, low quality of health care, and we're this unhealthy.

Imagine if nobody had to pay for anything anymore.

Aaron (28:46)
Oof.

Matt Allen (28:47)
You think everybody's gonna get healthier? People are gonna be like, I don't have to pay for any medications anymore? Load up. I don't have to pay for this surgery, I don't have to pay for this hospitalization. Why wouldn't I order dominoes every night? I think you would see the health get worse, thus creating a larger burden on the governmentally funded healthcare system.

Thus

making an even larger unfunded liability. So, my solution, empower people to confidently navigate the healthcare system. I don't have any say whether we go to Medicare for all or not. My opinion is one in three hundred and thirty million. Who cares? I'm here to help people with the system as it is. Right now, today, tomorrow.

And if it changes to Medicare for all, I welcome it with open arms and I'll help people navigate that system as well.

Aaron (29:44)
Love it. Like it or hate it, this is what we got, and we're gonna do what we can with what we got.

Matt Allen (29:52)
Love that. This has been another episode of Talking Shit. Shit, of course, is an acronym for straight health insurance talk. I am Matt Allen.

Aaron (30:00)
I am Aaron Miller.

Matt Allen (30:02)
Thanks for your time.

Why Health Insurance Is Different in Every State

Why Health Insurance Is Different in Every State Transcript

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