News Release

More Insurers Are Participating in the ACA Marketplaces in 2019

Insurer participation in the Affordable Care Act’s health insurance marketplaces is rising in 2019, finds a new analysis from KFF (the Kaiser Family Foundation).The increase follows consecutive years of improving insurance company profits and shows up in several different ways:

  • Going into 2019, 608 counties nationwide are gaining at least one insurer in the marketplace, while only five counties will lose an insurer.
  • In 2019, roughly 17 percent of enrollees (living in 37 percent of counties) will have access to just one insurer in the marketplace. That is down from 26 percent of enrollees living in 52 percent of counties in 2018.
  • There are an average of four insurers per state in the ACA marketplaces in 2019, ranging from one company in Alaska, Delaware, Mississippi, Nebraska and Wyoming to more than 10 in California, New York and Wisconsin. That is up from 3.5 insurers per state in 2018, though still lower than the peak of six per state in 2015.

Insurer participation varies greatly within states, and rural areas tend to have fewer insurers than do metropolitan areas. The analysis has data on the number of insurers by state and county from 2014 to 2019, including interactive maps highlighting changes at the county level.


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The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California.