Service Area

Issuers must identify the proposed service areas that will be associated with their QHPs, by state and by county. In most cases, HHS will only approve service areas covering full counties. In instances when the issuer proposes a service area that will cover only part of a county, the service area must also indicate associated zip codes. All issuers are required to submit service area information as part of their QHP Application.

Key Changes for PY2025:
  • Service Area Names must be identical within the same Service Area ID.
  • Service Area Names must be unique across Service Area IDs.
Tips for the Service Area Section
  • Dual-product issuers must create two different service area IDs, one each for QHPs and SADPs, regardless of whether the service area is intended to serve both plan types.
  • Dual-product issuers must use the word “dental” in the service area name for their dental service area to distinguish the dental service area from the QHP service area.
  • If the issuer offers plans in the Individual and Small Business Health Options Program (SHOP) Markets, the issuer must create separate service area IDs for each market, regardless of whether the service area is intended to serve both markets.
  • Issuers can make changes to their plan’s service area after the initial submission deadline without first submitting a data change request (DCR) for Centers for Medicare & Medicaid Services (CMS) authorization. After the final submission deadline in the PY2025 QHP Data Submission and Certification Timeline bulletin, a DCR is required for any change to QHP data, including service area.