Six states—including Georgia, Maine, and Wyoming —have passed laws to allow these compacts. However, as of early 2026, no states have actually joined together in a compact, and no insurers have yet offered a plan across state lines under these provisions.
The concept of buying medical insurance across state lines is often proposed as a way to increase competition and lower costs, yet it remains largely theoretical in practice. While federal and some state laws technically allow it, economic and logistical hurdles have prevented any widespread adoption as of 2026. Current Legal Status buying medical insurance across state lines
Patient Protection and Affordable Care Act - Federal Register While federal and some state laws technically allow
Under the Affordable Care Act (ACA) , specifically Section 1333, states are permitted to form "Health Care Choice Compacts". These agreements would allow insurers to sell a policy in multiple states while following the regulations of just one primary state. Most health insurance is still governed by the
Most health insurance is still governed by the McCarran-Ferguson Act of 1945 , which gives individual states primary authority over their own insurance markets. Why It Hasn't Happened The primary barriers are economic rather than legal: