States with the Most Insurance Issuers
All states ranked by number of competing health insurance companies — where consumers have the most choice.
What This Ranking Tells Us
Issuer competition is one of the strongest predictors of affordable premiums. States with more insurance companies competing in the marketplace tend to have lower premiums and more plan variety. The ACA marketplace has seen growing issuer participation in recent years, reversing early declines that left some counties with only one option. More issuers means consumers can shop across different provider networks, cost-sharing structures, and premium levels to find the best fit.
What the Data Reveals Across 30 States
This ranking covers 30 states and jurisdictions in the ACA marketplace. Texas tops the list at 18, while Wyoming sits at the opposite end with 2. The median value across all ranked states is 6, giving a rough sense of where a typical state lands relative to the extremes. The spread between top and bottom — 16 — illustrates how unevenly this particular metric is distributed across the country.
Rankings of this kind are shaped by a mix of structural factors: issuer competition, hospital and physician pricing, whether a state expanded Medicaid (which affects who enrolls in marketplace plans vs Medicaid), state-specific benefit mandates, and the age and health profile of each state's enrollment pool. Two states with similar demographics can still post very different numbers because of marketplace design choices and regulatory posture. The figures shown here are base rates — most enrollees pay less after Advance Premium Tax Credits are applied, with subsidy size keyed to each county's benchmark (second-lowest Silver) premium.
Use this ranking as a starting point for state-level comparison, not as a personalized recommendation. Your actual premium, deductible, and out-of-pocket exposure depend on age, household income, tobacco use, county of residence, and the specific plan you choose. Click any state to drill into county-level data, and always verify final pricing, provider networks, and subsidy eligibility at HealthCare.gov before enrolling. This page is informational only and is not insurance, medical, or tax advice. Source: CMS ACA Marketplace Public Use Files, Plan Year 2026.
| # | State | Issuers |
|---|---|---|
| 1 | Texas TX | 18 |
| 2 | Florida FL | 16 |
| 3 | Wisconsin WI | 12 |
| 4 | Ohio OH | 11 |
| 5 | Missouri MO | 8 |
| 6 | Arizona AZ | 7 |
| 7 | Michigan MI | 7 |
| 8 | Oklahoma OK | 7 |
| 9 | Arkansas AR | 6 |
| 10 | Iowa IA | 6 |
| 11 | Kansas KS | 6 |
| 12 | Louisiana LA | 6 |
| 13 | North Carolina NC | 6 |
| 14 | Oregon OR | 6 |
| 15 | South Carolina SC | 6 |
| 16 | Tennessee TN | 6 |
| 17 | Utah UT | 6 |
| 18 | Indiana IN | 5 |
| 19 | Mississippi MS | 5 |
| 20 | Nebraska NE | 5 |
| 21 | Alabama AL | 4 |
| 22 | New Hampshire NH | 4 |
| 23 | Delaware DE | 3 |
| 24 | Montana MT | 3 |
| 25 | North Dakota ND | 3 |
| 26 | South Dakota SD | 3 |
| 27 | Alaska AK | 2 |
| 28 | Hawaii HI | 2 |
| 29 | West Virginia WV | 2 |
| 30 | Wyoming WY | 2 |
Source: CMS ACA Marketplace Public Use Files, Plan Year 2026.
Frequently Asked Questions
Why does issuer competition matter?
Research consistently shows that premium growth is slower in markets with more competing insurers. Each additional insurer in a market is associated with 2-4% lower premiums on average. Competition forces insurers to negotiate better rates with providers, operate more efficiently, and offer competitive pricing to attract enrollees.
What is the typical number of issuers per state?
The national average is around 5-7 issuers per state, but this ranges from 2 in the least competitive states to 16+ in the most competitive. Many states saw issuer counts drop to 1-2 during 2017-2018, but participation has rebounded strongly since then as the marketplace stabilized.
Explore More Rankings
Read our methodology — how this data is sourced, computed, and verified.