States with the Most Insurance Issuers

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.