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States decide which specific benefits (like fertility treatments or acupuncture) must be covered.

Health insurance is primarily regulated at the state level rather than the federal level, a precedent set by the . This means each state is responsible for:

If you are moving or spend time in multiple states, you have options to maintain coverage: How Health Insurance Works When You Live in Multiple States

Under current laws for 2026, you must purchase health insurance in the state where you maintain your permanent legal residence.

State regulators oversee local plans to ensure they follow state laws and assist residents with disputes. The "Compact" Exception (The Fine Print)

While some states have passed laws allowing these pacts, as of early 2026, no states have successfully joined together to offer these plans.

The Affordable Care Act (ACA) actually includes a provision (Section 1333) that allows states to form "health care choice compacts" to sell insurance across state lines. However:

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How to install the ISE_14.7_VM using Oracle Virtual Box.