Insurer participation in ACA marketplaces up in 2019 though rural areas still have fewer; map shows county-level data

Orange counties have one insurer in 2019; light blue counties have two, and dark blue counties have more.
(Kaiser Family Foundation map; click the image to enlarge it or click here for the interactive version)

In 2019, more health insurers are participating in insurance marketplace exchanges established under the Patient Protection and Affordable Care Act, according to a new analysis of insurers from 2014 to 2019.

A number of insurers have entered the market or expanded services for 2019. The average state will have four insurers in 2019, ranging from five states with one insurer (Alaska, Delaware, Mississippi, Nebraska and Wyoming) to three states with more than 10 insurers (California, New York, and Wisconsin). Rural areas tend to have fewer than metro areas: "On average, metro-area counties have 2.3 insurers participating in 2019, compared to 1.8 insurers in non-metro counties. In 2018, 87 percent of enrollees lived in metro counties," Rachel Fehr, Cynthia Cox and Larry Levitt report for Kaiser Family Foundation.

An average of four insurers is lower than when the ACA marketplaces debuted in 2014, but up from last year. In 2014 an average of five insurers participated in each state's marketplace. The average rose to six insurers per state in 2015 and dipped slightly to 5.6 in 2016. In 2017 several high-profile insurers exited the market, leading to an average of 4.3 insurers per state. In 2018 the average dropped further to 3.5, most likely because of insurers' uncertainty about the future of the ACA, KFF reports.

Enrollment for an ACA health care plan ends Dec. 15.