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The Center for Consumer Information & Insurance Oversight

 

Market Rating Reforms

State Specific Geographic Rating Areas


The Market Rules and Rate Review Final Rule (45 CFR Part 147) provide that each state will have a set number of geographic rating areas that all issuers in the state must uniformly use as part of their rate setting. The default geographic rating areas for each state will be the Metropolitan Statistical Areas (MSAs) plus the remainder of the State that is not included in a MSA.States may seek approval from HHS for a number of geographic rating areas that is greater than the number of MSAs in the state plus one (MSAs+1), provided the rating areas are based on counties, three-digit zip codes, or MSAs/non-MSAs. If a state requests geographic rating areas in excess of MSAs+1, then the state must provide actuarial justification, and must demonstrate how they will reflect significant differences in health care unit costs by rating area, lead to stability in rates over time, apply uniformly to all health insurance issuers in a market, are based on one or more geographic boundaries described previously, and will not be unfairly discriminatory.

The table below provides information about each state’s market rating areas and method for dividing the state into rating areas, in the individual and small group markets.

■  Proposed: The "proposed" columns list each state’s proposed market rating areas and proposed method for dividing the state into rating areas. States' proposed rating areas must be submitted to HHS by March 29, 2013.
■  Implemented: The "implemented" columns indicate the market rating areas and the method for dividing the state into rating areas that a state actually implements, following communications with HHS. To view the specific rating areas being implemented for each state, click on the state name inside the table and a new page will open that lists the actual rating areas implemented.

Updated April 16, 2013

Individual and Small Group Market Geographic Rating Areas by State

State

Number of Proposed
Market Rating Areas

Proposed Market Geographic Rating Divisions

Number of Implemented Market Rating Areas

Implemented Market Geographic Rating Divisions

Alabama

13

MSAs+1

13

MSAs+1

Alaska

3

3-Digit Zip Codes

3

3-Digit Zip Codes

Arizona

7

Counties

7

Counties

Arkansas

7

Counties

7

Counties

California

19

Combination

19

Combination

Colorado

11

Counties

11

Counties

Connecticut

8

Counties

8

Counties

Delaware

1

Counties

1

Counties

District of Columbia

1

Counties

1

Counties

Florida

67

Counties

67

Counties

Georgia

16

Counties

16

Counties

Hawaii

1

Counties

1

Counties

Idaho

7

3-Digit Zip Codes

7

3-Digit Zip Codes

Illinois

13

Counties

13

Counties

Indiana

17

Counties

17

Counties

Iowa

7

Counties

7

Counties

Kansas

7

Counties

7

Counties

Kentucky

8

Counties

8

Counties

Louisiana

8

Counties

8

Counties

Maine

4

Counties

4

Counties

Maryland

4

Counties

4

Counties

Massachusetts

7

3-Digit Zip Codes

7

3-Digit Zip Codes

Michigan

16

Counties

16

Counties

Minnesota

9

Counties

9

Counties

Mississippi

6

Counties

6

Counties

Missouri

10

Counties

10

Counties

Montana

4

Counties

4

Counties

Nebraska

 4

3-Digit Zip Codes 

 3-Digit Zip Codes

Nevada

4

Counties

4

Counties

New Hampshire

1

Counties

1

Counties

New Jersey
(Individual Market)

1

Counties

1

Counties

New Jersey
(Small Group Market
)
6Counties6Counties
New Mexico

5

MSAs+1

5

MSAs+1

New York

8

Counties

8

Counties

North Carolina

16

Counties

16

Counties

North Dakota

4

MSAs+1

4

MSAs+1

Ohio

17

Counties

17

Counties

Oklahoma

5

MSAs+1

5

MSAs+1

Oregon

7

Counties

7

Counties

Pennsylvania

9

Counties

9

Counties

Rhode Island

1

Counties

1

Counties

South Carolina

46

Counties

46

Counties

South Dakota

4

Counties

4

Counties

Tennessee

8

Counties

8

Counties

Texas

26

MSAs+1

26

MSAs+1

Utah

6

Counties

6

Counties

Vermont

1

Counties

1

Counties

Virginia

12

MSAs+1

12

MSAs+1

Washington

5

Counties

5

Counties

West Virginia

11

Counties

11

Counties

Wisconsin

16

Counties

16

Counties

Wyoming

3

MSAs+1

3

MSAs+1

American Samoa

1

Counties

1

Counties

Guam

1

Counties

1

Counties

Northern Mariana Islands

1

Counties

1

Counties

Puerto Rico

1

Counties

1

Counties

US Virgin Islands

1

Counties

1

Counties