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Insurer Participation on ACA Marketplaces, 2014-2017

Since the Affordable Care Act health insurance marketplaces opened in 2014, there have been a number of changes in insurance participation as companies entered and exited states and also changed their footprint within states. Our earlier analyses of insurer participation and some notable company exits can be found here.

In 2014, there were an average of 5.0 insurers participating in each state’s ACA marketplace, ranging from 1 company in New Hampshire and West Virginia to 16 companies in New York. 2015 saw a net increase in insurer participation, with an average of 6.0 insurers per state, ranging from 1 in West Virginia to 16 in New York. In 2016, insurer participation changed in a number of states due to a combination of some new entrants and the failure of a number of CO-OP plans. In 2016, the average number of companies per state was 5.6, ranging from 1 in Wyoming to 16 in Texas and Wisconsin.

In 2017, insurance company losses led to a number of high profile exits from the market. The average number of companies per state in 2017 was 4.3, ranging from 1 company in Alabama, Alaska, Oklahoma, South Carolina and Wyoming to 15 companies in Wisconsin. In 2017, 58% of enrollees (living in about 30% of counties) had a choice of three or more insurers, compared to 85% of enrollees (living in about 63% of counties) in 2016.

Insurer participation varies greatly within states, and rural areas tend to have fewer insurers. On average, metro-area counties have 2.5 insurers participating in 2017, compared to 2.0 insurers in non-metro counties. In 2017, 87% of enrollees lived in metro counties.

The map below shows how insurance participation has changed from 2014 – 2017 in every county in the U.S. Data for this map are available for download.

There are a number of areas in the country with just one exchange insurer. In 2017, about 21% of enrollees (living in 33% of counties) have access to just one insurer on the marketplace (up from 2% of enrollees living in 7% of counties in 2016). Often, when there is only one insurer participating on the exchange, that company is a Blue Cross Blue Shield or Anthem plan. Before the ACA, many state individual markets were often dominated by Blue Cross Blue Shield plans.

Table 1: Total Number of Insurers by State, 2014 – 2017
Total Number of Issuers in the Marketplace
State 2014 2015 2016 2017
Alabama 2 3 3 1
Alaska 2 2 2 1
Arizona 8 11 8 2
Arkansas 3 3 4 3
California 11 10 12 11
Colorado 10 10 8 7
Connecticut 3 4 4 2
Delaware 2 2 2 2
DC 3 3 2 2
Florida 8 10 7 5
Georgia 5 9 8 5
Hawaii 2 2 2 2
Idaho 4 5 5 5
Illinois 5 8 7 5
Indiana 4 8 7 4
Iowa 4 4 4 4
Kansas 3 3 3 3
Kentucky 3 5 7 3
Louisiana 4 5 4 3
Maine 2 3 3 3
Maryland 4 5 5 3
Massachusetts 10 10 10 9
Michigan 9 13 11 9
Minnesota 5 4 4 4
Mississippi 2 3 3 2
Missouri 3 6 6 4
Montana 3 4 3 3
Nebraska 4 4 4 2
Nevada 4 5 3 3
New Hampshire 1 5 5 4
New Jersey 3 5 5 2
New Mexico 4 5 4 4
New York 16 16 15 14
North Carolina 2 3 3 2
North Dakota 3 3 3 3
Ohio 12 15 14 10
Oklahoma 4 4 2 1
Oregon 11 10 10 6
Pennsylvania 7 8 7 5
Rhode Island 2 3 3 2
South Carolina 3 4 3 1
South Dakota 3 3 2 2
Tennessee 4 5 4 3
Texas 11 14 16 10
Utah 6 6 4 3
Vermont 2 2 2 2
Virginia 5 6 7 8
Washington 7 9 8 6
West Virginia 1 1 2 2
Wisconsin 13 15 16 15
Wyoming 2 2 1 1
US Average 5.0 6.0 5.6 4.3
SOURCE:  Kaiser Family Foundation analysis of insurer rate filings to state regulators
NOTES: Insurers are grouped by parent company or group affiliation, which we obtained from HHS Medical Loss Ratio public use files and supplemented with additional research.

Methods

Data were gathered from healthcare.gov and state-based exchange enrollment websites and insurer rate filings to state regulators. Companies and related subsidiaries were grouped by their parent or group affiliation using Mark Farrah Associates Health Coverage Portal TM and the Health and Human Services (HHS) Medical Loss Ratio data. Enrollment in states using Healthcare.gov is from HHS (with some adjustments made for counties without reported enrollment). In states running their own exchanges, we gathered county-level data where possible, and if unavailable estimated county level enrollment based on the state’s enrollment total.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.