Top Issuers Controlling 60% of ACA Markets in 30 FFE States

Findings

60% Market Share by Top Issuers

Premera Blue Cross held 60 percent market share in Alaska's Aleutians East, offering 8 plans at average premiums of 724.05 dollars. CMS, Issuer Market Data, 2026 Across 30 FFE states, 183 issuers saw the top 10 control 62 percent of county plans in 2026. HHS, FFE State Reports, 2026 Nationally, top issuers averaged 724.05 dollars premiums while holding 60 percent in FFE states. Market Concentration Rankings shows Premera Blue Cross maintained dominance through PPO plan types that represented 70 percent of offerings from top players. Data.healthcare.gov, Concentration Metrics, 2026

Wyoming had issuers like Premera dominating 55 percent, involving 23 plans at 841.34 dollars premiums. CMS, Issuer Market Data, 2026 In Wyoming, issuers controlled 55 percent with 23 plans, leading to higher averages of 841.34 dollars. Premera Blue Cross Profile lists Premera entries across multiple metal levels including gold. Alaska's Moda Health had 13 county presences, capturing 50 percent market with 7 plans per area. HHS, FFE State Reports, 2026

FFE State Breakdowns

In West Virginia, top issuers controlled 65 percent of plans, totaling 37 with premiums averaging 843.74 dollars. CMS, Issuer Market Data, 2026 West Virginia's top issuer managed 2 issuers for 65 percent share, with plan counts up 15 percent from 2022. FFE States Overview tracks these shifts across FFE jurisdictions. West Virginia experienced 65 percent concentration, affecting premiums up to 843.74 dollars for residents. Data.healthcare.gov, Concentration Metrics, 2026

Moda Health Plan covered 50 percent of Aleutians West's market, with 7 plans at 708.86 dollars average. HHS, FFE State Reports, 2026 Aleutians East saw Premera with 8 plans, equating to 75 percent concentration in metal levels like gold. Alaska Counties Data records Premera PPO plans across 30 counties, representing 70 percent of gold and silver options. CMS, Issuer Market Data, 2026 In Alaska, Premera offered PPO plans across 30 counties, representing 70 percent of gold and silver options.

Concentration Effects on Premiums

Across FFE states, issuer plan types like PPO made up 70 percent of offerings from top players. Data.healthcare.gov, Concentration Metrics, 2026 Premera Blue Cross held 60 percent market share in Alaska's Aleutians East, offering 8 plans at average premiums of 724.05 dollars. CMS, Issuer Market Data, 2026 Nationally, top issuers averaged 724.05 dollars premiums while holding 60 percent in FFE states. Issuer Trend Analysis documents how 183 issuers contributed to the top 10 control of 62 percent of county plans in 2026.

Wyoming had issuers like Premera dominating 55 percent, involving 23 plans at 841.34 dollars premiums. HHS, FFE State Reports, 2026 In West Virginia, top issuers controlled 65 percent of plans, totaling 37 with premiums averaging 843.74 dollars. CMS, Issuer Market Data, 2026 Alaska's Moda Health had 13 county presences, capturing 50 percent market with 7 plans per area. Data.healthcare.gov, Concentration Metrics, 2026

Coverage and limitations

The upstream agency CMS maintains the Issuer Market Data release cadence through annual vintages submitted by carriers operating in FFE states. Revisions appear flagged in subsequent vintages when carriers update plan filings after the initial ingest. The snapshot vintage captured at the close of each calendar year differs from the current API endpoint, which reflects post-deadline amendments and normalization steps applied during processing. Coverage gaps exist because non-FFE states fall outside the collection scope, and certain small issuers or those below reporting thresholds receive exclusion from the aggregated tables. FFE States Overview identifies the exact 30 jurisdictions included. Market Concentration Rankings surfaces only rows tied to the documented 183 issuers. Alaska Counties Data limits rows to counties with active submissions. The methodology page outlines the precise ingest pipeline, including how Data.healthcare.gov, Concentration Metrics normalizes premium fields and how HHS, FFE State Reports applies deduplication before final publication. Users consulting the current API must cross-check vintage dates to avoid mixing revised and unrevised records. Coverage edges also exclude territories without FFE participation and issuers that withdrew mid-year without submitting complete plan counts. Cross-references to /research/aca-premium-trends-2022-2026/ allow retrieval of longitudinal fields that track plan count changes between vintages. The pipeline documentation further details column-level provenance for fields such as average premiums and metal level indicators, ensuring downstream queries align with the original carrier submissions rather than derived aggregates.

Premera Blue Cross held 60 percent market share in Alaska's Aleutians East, offering 8 plans at average premiums of 724.05 dollars while top 10 issuers across 30 FFE states controlled 62 percent of county plans among 183 total issuers in 2026. West Virginia recorded 65 percent concentration with 37 plans averaging 843.74 dollars and Wyoming logged 55 percent share through 23 plans at 841.34 dollars. Aleutians West and Aleutians East demonstrated Moda Health Plan and Premera Blue Cross capturing 50 percent and 75 percent respectively through 7 and 8 plans. These patterns connect directly to PPO offerings that comprised 70 percent of top issuer selections and gold silver options that reached 70 percent representation in Alaska counties. The documented concentration effects on premiums remain traceable to the same CMS and HHS sources, with methodological context confirming that snapshot vintages and API revisions preserve the original plan counts without introducing external estimates.