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.

To view the specific rating areas for each state, click on the state name inside the table and a new page will open that lists the actual rating areas.

Updated September 20, 2022

Individual and Small Group Market Geographic Rating Areas by State