State-by-state look at ACA individual marketplaces

Government health exchanges are on track to offer shoppers fewer options than ever before in 2017.

Recent studies from the Kaiser Family Foundation and Avalere Health suggest one-third of all U.S. counties will only have one insurer offering plans on Affordable Care Act exchanges in 2017, leaving an estimated 2.3 million ACA marketplace enrollees in uncompetitive markets. High-profile exits like UnitedHealthcare and Aetna, as well as double-digit premium rate increases nationwide, have caused some experts to question the individual market's long-term viability.

Still, the exchanges have positively impacted healthcare access across the country. Reforms introduced under the ACA have expanded coverage to nearly 20 million Americans between 2010 and 2016. America's uninsured rate reached a historic low of 8.6 percent in the first quarter of 2016. And while millions will face uncompetitive individual markets next year, the majority (62 percent) of 2017 individual marketplace enrollees are projected to be able to choose from three or more insurers next year.

The following is a state-by-state look at 2017 ACA individual marketplaces. 

This list was last updated Oct. 19 at 5:09 p.m. CST.

Alabama

Overall market: Blue Cross Blue Shield of Alabama is the only insurer selling plans through the state exchange in 2017 following Humana and UnitedHealthcare's departure at the end of 2016.

Average rate increase: The insurer was approved the following average rate hike:

  • BCBS of Alabama (36 percent)

Medicaid: Alabama did not expand its Medicaid program under the ACA. It is struggling to find alternative sources of money to continue funding its Medicaid program, including implementing a lottery and re-allocating BP oil spill reparations. It is currently reconsidering Medicaid expansion.

Alaska

Overall market: Premera is the only insurer selling individual plans through the state exchange in 2017 following Moda Health's exit at the end of 2016. In light of the news, policymakers and Premera officials predicted the insurer could not realistically raise rates high enough to cover customers' medical bills. To prevent Alaska's marketplace from folding, state legislators set up a $55 million fund — financed through an existing tax on all insurers — to subsidize enrollees' costs as insurers exit Alaska's marketplace.

Average rate increase: The insurer requested the following rate hike:

  • Premera (9.6 percent)

Medicaid: Alaska expanded Medicaid under the ACA, despite serious opposition from Republican state lawmakers. Some lawmakers sued Gov. Bill Walker (I) for expanding the program. 

Arizona

Overall market: Arizona has experienced one of the steepest declines in insurer competition on its ACA exchange between 2016 and 2017. Arizona is one of several states that have become insurance deserts in 2017. However, Blue Cross Blue Shield's decision not to leave Arizona entirely has assuaged some policymakers' fears the exchange would fold.

Residents in approximately 87 percent of Arizona's counties will have only one carrier offering plans in 2017. Pinal County in Arizona, which regulators feared wouldn't have an insurer at all, gained coverage from BCBS of Arizona on Sept. 8.

UnitedHealthcare, Aetna, Health Choice, Phoenix Health Plan and Humana will exit the market in 2017. Cigna, BCBS of Arizona and Centene will sell plans on the market next year.

Average rate increases: The weighted average increase for premiums is 49.3 percent next year. Insurers on the exchange requested the following rate hikes:

  • Cigna (8.7 percent)
  • BCBS of Arizona (64.9 percent)
  • Health Net (29.1 percent)
  • Centene (new entrant)

Medicaid: Arizona expanded its Medicaid program under the ACA. Arizona re-opened new member enrollment in its Children's Health Insurance Program in July, reversing a six-year enrollment freeze.

Co-op: The Arizona Department of Insurance put failed insurance co-op Meritus Health Partners and Meritus Mutual Health Partners in receivership for lack of assets to pay provider claims Aug. 11, after the insurer was suspended from doing business Oct. 31, 2015.

Arkansas

Overall market: United Healthcare will exit the market in 2017.

Average rate increases: Insurance regulators approved the following rate hikes in September:

  • BCBS of Arkansas (9.7 percent)
  • Centene Celtic Insurance (4 percent)
  • QualChoice (23.7 percent)
  • QCA Health Plan (13.5 percent)
  • QualChoice Life and Health (13.5 percent)

Medicaid: Arkansas has a private option Medicaid model. The state-run program uses Medicaid funds to purchase private plans through the exchange for Medicaid-eligible consumers.  

California

Overall market: California residents who enroll in plans on the individual exchange will have plenty of competition to choose from. Eleven carriers will offer plans in 2017. The statewide average rate increase next year will be 13.2 percent, according to calculations from Covered California, one of ten state-run exchanges that negotiates directly with carriers to ensure rates, networks and benefits are consumer friendly. Covered California pointed out some insurers have expanded their coverage areas, which may make shopping health plans more productive for some enrollees.

UnitedHealthcare will exit California's individual marketplace and Oscar Health Plan will expand into San Francisco in 2017.

Average rate increases: The following 11 insurers in the marketplace have requested the following average rate increases:

  • Anthem Blue Cross of California (17.3 percent)
  • Blue Shield of California (19.2 percent)
  • Chinese Community Health Plan (16.6 percent)
  • Health Net (9.1 percent)
  • Sharp Health Plan (7.8 percent)
  • Kaiser Permanente (5.6 percent)
  • LA Care Health Plan (3.8 percent)
  • Molina Healthcare (5.3 percent)
  • Oscar Health Plan of California (11.3 percent)
  • Valley Health Plan (0.8 percent)
  • Western Health Advantage (7.7 percent)

Medicaid: California expanded its Medicaid program under the ACA. The state still has a significant uninsured rate. More than 3.8 million residents were uninsured in 2015, two million of which qualified for Medi-Cal benefits. The federal government updated California's 1115 waiver early this year, bumping up its uncompensated care funding to $1.8 billion over the next four years.

Colorado:

Overall market: Humana and UnitedHealthcare will exit the market at the end of 2016. Rocky Mountain HMO has discontinued individual plans in every county except for Mesa County. Anthem Blue Cross Blue Shield will stop offering its preferred provider organization plans. These insurers' policy changes will affect nearly 100,000 state residents who purchased plans through the exchange in 2016. Some counties will have only one payer offering individual plans through the exchange in 2017.

Bright Health Insurance gained regulatory approval to offer plans both on and off the exchange in 2017.

Colorado voters will vote this fall to implement a universal coverage system that would go into effect in 2019, if approved.

Average rate increases: Regulators approved an average 20 percent rate hike in 2017.  Insurance regulators approved the following average rate changes for insurers:

  • Cigna (9.5 percent increase)
  • Colorado Choice (proposed 42.9 percent increase)
  • Denver Health Medical Plan (0.5 percent decrease)
  • Anthem Blue Cross Blue Shield (25.8 percent increase)
  • Kaiser (18 percent increase)
  • Rocky Mountain HMO (34.9 percent increase)
  • Bright Health Plans (new to market)

Medicaid: Colorado expanded its Medicaid program under the ACA.

Co-op: Colorado HealthOP closed in October 2015. The insurer fought the state insurance department's decision, claiming it had a strong financial position. However, it received $2 million out of $12 million in reimbursement owed by the federal government under the risk corridor program. This caused the carrier's rainy day fund to fall below minimum requirements set by insurance regulators to sell products on the exchange.

Connecticut

Overall market: Two of the state's four carriers that offered plans on the exchange in 2016 will exit in 2017. One of the remaining two insurers, ConnectiCare, sued the state insurance department and temporarily withdrew from the exchange after insurance regulators denied its requested average rate increase of 27.1 percent.

 Average rate increases: The state insurance department approved the following rate increases:

  • Anthem (22.4 percent)
  • ConnectiCare (17.4 percent)

Medicaid: Connecticut expanded its Medicaid program under the ACA.

Co-op:
Insurance regulators placed HealthyCT into receivership July 5. The insurer will continue to pay beneficiaries' claims through the end of the year. HealthyCT escaped the initial wave of co-op failures in the fall of 2015, but when it was determined that it would owe $13.4 million in risk adjustment payments, regulators determined the payer wouldn't remain operational. The shutdown affects 13,000 enrollees.

Delaware

Overall market: The two insurers that offered plans on the ACA marketplace in 2016 will remain in 2017. Delaware is one of four states where Aetna will offer plans on the ACA exchange. In 2016, nearly 85 percent of Delaware exchange enrollees received subsidies for coverage.

Average rate increases: Approved rate increases per insurer are as follows:

  • Aetna (23.6 percent)
  • Highmark BCBS of Delaware (32.5 percent)

Medicaid: Delaware expanded its Medicaid program under the ACA.

Florida

Overall market: UnitedHealthcare will exit Florida's ACA exchange in 2017, leaving 44 of Florida's 67 counties with only one carrier offering plans. Harken Health, a subsidiary of UnitedHealthcare, initially applied for approval to sell plans on Florida's exchange but reversed its decision in August. Aetna will also exit in 2017. Humana notified regulators it would scale back the number of counties in which it will offer plans.

Cigna, however, will re-enter the market after departing from Florida's exchange in 2015. Florida currently boasts eight insurers in its exchange in 2017.

Average rate increases: Participating insurers' premiums will increase by an average of 19 percent next year. Insurance regulators approved the following rate increases:  

  • Florida Blue (19 percent)
  • Celtic Insurance (20 percent)
  • Florida Healthcare Plan (15.4 percent)
  • Health First (11.7 percent)
  • Health Options (18.9 percent)
  • Humana (36.8 percent)
  • Molina Healthcare of Florida (17.4 percent)

Medicaid: Florida has not expanded its Medicaid program under the ACA.

Georgia

Overall market: Four of nine carriers that offered plans on the exchange this year will exit at the end of 2016: Aetna, UnitedHealthcare, its subsidiary Harken Health and Cigna. Aetna's departure has caused BCBS of Georgia to consider raising its requested rate hike as it prepares to absorb new enrollees. BCBS is the only insurer to offer plans in every county.

Average rate increases: Insurers average requested rate increases are as follows:

  • Blue Cross Blue Shield of Georgia (15.1 percent)
  • Humana (67.5 percent)
  • Kaiser Permanente (18 percent)
  • Ambetter from Peach State Health Plan (7.4 to 8.3 percent, depending on dental or vision coverage)
  • Alliant (10 percent)

Medicaid: Georgia is one of 19 states that chose not to expand its Medicaid program under the ACA. However, legislators introduced a bill in February that calls for premium assistance to help people with incomes of up to 138 percent of the federal poverty level purchase plans through the exchange.

Hawaii

Overall market: After two years of using a technologically troubled state-based enrollment system, Hawaii began using the federal Healthcare.gov platform in 2016. Hawaii has just two carriers offering individual health insurance plans both on and off the exchange. Hawaii Medical Service Association launched a capitated payment pilot program in 2016. HMSA will use the capitated model for all of its primary care physicians in 2017.

Average rate increases: Insurers proposed the following average rate hikes:

  • Hawaii Medical Service Association (35 percent)
  • Kaiser Foundation Health Plan (25.9 percent)

Medicaid: Hawaii expanded its Medicaid program under the ACA. However, Hawaii's uninsured rate has consistently been lower than the U.S. average due to the Hawaii Prepaid Healthcare Act, which requires employers to provide health insurance to employees who work at least 20 hours a week. In 2015, Hawaii was among one of nine states that had an uninsured rate less than 7 percent.

Idaho

Overall market: Every county in Idaho will have five or more carriers offering individual plans through the exchange in 2017. Montana's Mountain Health Co-op expanded into Idaho's marketplace in 2014, and it will continue to offer individual plans in 2017. In December 2015, a Leavitt Partners study called Idaho's exchange a "model for state based adoption [of an exchange]" and noted that the exchange has a budget well below average, a "lean organizational structure" and "strong financial controls."

The Idaho Department of Insurance does not have the authority to prevent health insurers from implementing rate increases it deems unjustified.

Average rate increases: Regulators approved the following average rate increases in 2017:

  • Blue Cross of Idaho (19 percent)
  • BridgeSpan (23 percent)
  • Mountain Health Co-op (29 percent)
  • SelectHealth (29 percent)
  • PacificSource (15 percent)
  • Regence BlueShield of Idaho (25 percent)

Medicaid: Montana has not expanded Medicaid under the ACA. Idaho's House of Representatives killed a Senate-approved bill that would have expanded the state's Medicaid program in March. Legislators are considering more modest healthcare legislation aimed to help Idaho's population that falls into the coverage gap, or the population that makes an annual income below the federal poverty line but is ineligible for Medicaid assistance.

Illinois

Overall market: Aetna, UnitedHealthcare and its subsidiary Harken Health will exit Illinois' market in 2017. Cigna will sell individual health plans on the ACA marketplace in the Chicago area for coverage beginning Jan. 1. Prior to Cigna's entrance, the Illinois Department of Insurance said three-fourths of Illinois counties will have one or two payers offering coverage next year on the state's ACA exchange. 

Average rate increases: Insurers were approved the following average rate hikes for 2017:

  • Blue Cross Blue Shield of Illinois (50.8 percent)
  • Celtic Insurance, Ambetter (47.8 percent)
  • Cigna (new to market)
  • Conventry (13.4 percent)
  • Health Alliance Medical Plans (30.4 percent)
  • Humana (46.3 percent) 

Medicaid: Illinois expanded its Medicaid program under the ACA.

Co-op:
Insurance regulators took control of Land of Lincoln Health July 13 in light of $31.8 million it owed in risk adjustment payments to the federal government. Approximately 49,000 beneficiaries were affected by the closure. The insurer filed suit against the federal government in June, claiming it is owed more than $70 million in risk corridor payments.

Indiana

Overall market: Five carriers will offer plans in the Indiana exchange in 2017. Three insurers — All Savers (a subsidiary of UnitedHealthcare), Southeastern Indiana Health Organization and Physicians Health Plan — will leave the market at the close of 2016. Aetna filed rate proposals to join the exchange, then withdrew its request in August.

Average rate increases: The overall average approved statewide increase was 18.5 percent. Insurance regulators approved insurers' rate requests as follows:

  • Anthem BCBS (29 percent)
  • CareSource Indiana (16.1 percent)
  • Celtic (-5.3 percent)
  • Indiana University Health Plans (14.9 percent)
  • MDWise (11.5 percent)

Medicaid: Indiana opened enrollment in its expanded Medicaid program in February 2015. The Healthy Indiana Plan requires newly eligible beneficiaries to contribute to a health savings account and to pay co-payments for emergency and non-emergency healthcare services.

Iowa

Overall market: Wellmark Blue Cross and Blue Shield has committed to joining the Iowa exchange in 2017, although it will only offer plans in 47 of 99 counties in the state. UnitedHealthcare will exit the individual market next year, affecting about 9,000 state residents.

Average rate increases: Insurance regulators approved the following average rate hikes for individual plans in 2017:

  • Aetna (22.6 percent)
  • Gundersen Health Plan (19.8 percent)
  • Medica (19 percent)
  • Wellmark (new to market)

Medicaid: Iowa expanded Medicaid under the ACA, but with a waiver that allowed insurance regulators to use Medicaid funds to help residents purchase private health plans. The state reversed its decision in June 2015, instead switching enrollees to Medicaid managed care plans administered by three commercial insurance carriers — AmeriHealth Caritas, Amerigroup and UnitedHealthcare.

The transition, which took effect in March, has sparked anger from some providers and healthcare organizations who claim the carriers have fallen months behind on reimbursement payments during the transition.

Kansas

Overall market: UnitedHealthcare entered the individual insurance market this year and will exit at the end of 2016. Blue Cross Blue Shield and Medica, which is new to the market, will offer plans next year. One of Blue Cross Blue Shield's three subsidiary plans will exit the exchange at the end of the year — Blue Cross Blue Shield of Kansas. 

Average rate increases: Insurers requested the following average rate increases for individual plans in 2017:

  • Blue Cross Blue Shield of Kansas Solutions (47.41 percent)
  • Blue Cross Blue Shield of Kansas City (28.1 percent)
  • Medica (new to market)

Medicaid: Kansas Gov. Sam Brownback (R) reduced Medicaid funding by more than $120 million in combined federal and state money in fiscal year 2017. Healthcare providers who serve Medicaid patients saw reimbursement rates drop by 4 percent in July. Healthcare advocates fear the funding reduction will cause a number of crucial healthcare providers to fold due to financial strain.

Kentucky

Overall market: Four carriers that offered plans on the exchange in 2016 will leave the market next year — Aetna, WellCare, Baptist Health and UnitedHealthcare. The federal government granted cautious approval Oct. 4 for Kentucky Gov. Matt Bevin (R) to unplug the state's health exchange Kynect, rerouting enrollees to the federal Healthcare.gov exchange.

Average rate increases: Insurance regulators approved the following average rate increases for individual plans in 2017:

  • Anthem Blue Cross Blue Shield (22.9 percent)
  • CareSource Kentucky (22.6 percent)
  • Humana (33.7 percent)

Medicaid: Kentucky's uninsured rate plummeted from 14.3 percent to 6 percent after former Gov. Steve Beshear (D) expanded Medicaid eligibility in 2013. State legislators submitted a proposal to HHS this year that would implement premiums and require community service from eligible members. HHS is unlikely to approve changes to Kentucky's Medicaid program that would limit access to care for residents, according to policy experts.

Louisiana

Overall market: UnitedHealthcare will exit the individual market in 2017, affecting approximately 214,000 residents. According to an analysis by Kaiser Family Foundation, UnitedHealthcare currently offers one of the two lowest-priced silver plans in the exchange in 50 of the state's 64 counties. The insurer's exit is expected to leave 59 of the state's counties with just two carriers offering plans in the exchange.

Average rate increases: Insurers requested the following average rate increases for individual plans in 2017:

  • Blue Cross Blue Shield of Louisiana (28 percent)
  • Humana (29.5 percent)
  • Vantage Health Plan (30.4 percent)
  • HMO Louisiana (22.86 percent)

Medicaid: Louisiana expanded its Medicaid program in July. More than 305,000 adults have enrolled to date. The federal government will pay 100 percent of the costs for the state's newly enrolled beneficiaries through the end of 2016, and the state gradually will take on up 10 percent of the costs by 2020. 

Co-op: In July 2015, the Louisiana Health Cooperative announced it would not participate in the 2016 period, and that existing policies would terminate at the end of 2015. Louisiana Health Cooperative was the second co-op to fail out of the 23 co-ops established under the ACA.

Maine

Overall market: Five carriers offered individual plans on the exchange in 2016, including the PPO and HMO arms of Harvard Pilgrim. Aetna and Harvard Pilgrim PPO will exit the exchange in 2017. Anthem, Community Health Options and Harvard Pilgrim HMO will offer plans in every county in Maine in 2017.

Average rate increases: Insurers proposed the following average rate increases:

  • Anthem (14.1 percent)
  • Community Health Options (22.8 percent)
  • Harvard Pilgrim HMOs (18.7 percent)

Medicaid: Maine has not expanded its Medicaid program under the ACA.

Co-op: 
Maine Community Health Options is one of the six remaining co-ops. Maine's co-op has contracted with a new pharmacy benefit manager, Express Scripts, with the aim of saving about $14 million annually by paying lower drug prices. It has 80,000 members, about 60 percent of the ACA marketplace in the state. But the co-op estimated it has less than 5 percent of the market when large employers are included.

Maryland

Overall market: UnitedHealthcare is the only insurer slated to exit the exchange at the end of the year. Four carriers will continue to offer plans in each county in the state.

Average rate increases: Insurers proposed the following average rate increases:

  • CareFirst Blue Choice, HMO (12.4 percent)
  • CareFirst Blue Cross Blue Shield (16 percent)
  • Cigna (29.8 percent)
  • Evergreen Health (8 percent)
  • Kaiser Permanente (25 percent)

Medicaid: Maryland expanded its Medicaid program under the ACA.

Co-op: 
Maryland's Evergreen Health is one of the six remaining nonprofit co-ops. Evergreen Health filed suit against the federal government earlier this year, challenging the $24 million in risk-adjustment payments the government says it owes. The insurer filed a request Oct. 3 to transition to a for-profit company to avoid a potential shutdown. The transition is pending state and federal approval.

Massachusetts

Overall market: According to the June 2016 enrollment report for Massachusetts Health Connector, more than two-thirds of the exchange's enrollees are covered by one of three health insurance carriers: Neighborhood Health Plan, Tufts Health Direct and Harvard Pilgrim. The other eight carriers combined have just 32 percent of the exchange enrollees.

UnitedHealthcare is the only insurer that will exit the market at the end of the year.

Average rate increases: Insurers requested the following average rate changes for individual plans in 2017:

  • Ambetter (6.6 percent increase)
  • Blue Cross Blue Shield of Massachusetts HMO Blue (6 percent increase)
  • Blue Cross Blue Shield of Massachusetts (8.2 percent increase)
  • Boston Medical Center HealthNet Plan (8.3 percent decrease)
  • Fallon Community Health Plan (1.3 percent increase)
  • Harvard Pilgrim Health Care HMO (15.2 percent increase)
  • Health New England (5.6 percent increase)
  • Minuteman Health Plan (18.9 percent increase)
  • Tufts HMO (7.6 percent increase)
  • Tufts Insurance Company (7.4 percent increase)

Medicaid: Massachusetts expanded its Medicaid program under the ACA.

Michigan

Overall market: Michigan has maintained one of the most robust marketplaces in the country. The region around Detroit, for instance, has some of the greatest market competition in the country, according to Vox. Four payers — Harbor Health Plan, UnitedHealthcare, Priority Health Insurance preferred provider organization and Alliance Health and Life Insurance PPO — will all exit Michigan's 2017 Affordable Care Act marketplace. Approximately 10,000 consumers will be affected.

Average rate increases: Insurers were approved the following average rate increases for individual plans in 2017:

  • Blue Care Network of Michigan (14.8 percent)
  • Blue Cross Blue Shield of Michigan (18.7 percent)
  • Health Alliance Plan (16.8 percent)
  • Humana Medical Plan of Michigan (39.2 percent)
  • McLaren Health Plan (12.2 percent)
  • Meridian Health Plan of Michigan (9.3 percent)
  • Molina Healthcare of Michigan (3.2 percent)
  • Physicians Health Plan (6.7 percent)
  • Priority Health (13.9 percent)

Medicaid: Michigan expanded its Medicaid program under the ACA.

Minnesota

Overall market: Insurers were approved average premium increases for individual plans between 50 percent and 67 percent for 2017. BCBS of Minnesota announced in June it would stop offering individual health plans on the exchange, affecting about 103,000 individuals. HealthPartners will not sell plans beyond the Twin Cities and St. Cloud regions. 

In an effort to recruit more carriers to offer plans through the marketplace in 2017 — particularly outside the Minneapolis metro area — state regulators sent out a request for proposals from health insurers on Aug. 15 and offered to waive certain regulations to make approval for participation more straightforward. No applicants surfaced.

Average rate increases: Insurers were approved the following average rate increases for on exchange individual plans in 2017:

  • HealthPartners (50 percent)
  • UCare (66.8 percent)
  • Medica Health Plans of Wisconsin (59.4 percent)

Medicaid: In 2015, Minnesota's uninsured rate was less than 4.5 percent, well below the national average of 9.1 percent at the time. Minnesota's Medicaid program has grown by more than 200,000 people since 2013 due to the expansion in eligibility under the ACA. 

Mississippi

Overall market: UnitedHealthcare will exit Mississippi's exchange at the end of 2016, leaving only two carriers that will offer plans in 2017. About 80 percent of Mississippi's counties will have only one carrier to choose from next year, according to Kaiser Family Foundation.

Average rate increases: Insurers requested the following average rate increases for individual plans in 2017:

  • Humana (43 percent)
  • Magnolia Health (7 percent)

Medicaid: Mississippi is one of 19 states that chose not to expand its Medicaid program under the ACA.

Missouri

Overall market: Four carriers will offer plans on the exchange in 2017, but almost 85 percent of counties will only have one carrier from which to choose.

Average rate increases: Insurers requested the following average rate increases for individual plans in 2017:

  • Blue Cross Blue Shield of Kansas City (29 percent)
  • Cigna (9 percent)
  • Healthy Alliance Life (20.6 percent)
  • Humana (34.9 percent)

Medicaid: Missouri submitted a waiver to CMS to expand its Medicaid program in 2016. The proposal included a provision that would allow physicians to bill Medicaid patients penalty fees for missing medical appointments, and charge recipients $8 co-pays to receive treatment in an emergency room for a non-emergency health issue. The federal government is expected to respond by January 2017.

Montana

Overall market: Three insurers will participate on Montana's federally-facilitated marketplace in 2017. 

Average rate increases: The following average rate increases were approved for the three insurers for 2017:

  • Blue Cross and Blue Shield of Montana (50.3 percent)
  • Mountain Health Cooperative (29 percent)
  • PacificSource (30.4 percent)

Medicaid: Montana expanded Medicaid effective Jan. 1, 2016. Montana Medicaid enrollment as of July was 47,399 — nearly double initial projections of 25,000 expected enrollees. Recipients have used their benefits to receive $75 million worth of healthcare services, according to state figures.

Co-op: 
Montana houses one of six remaining health cooperatives created under the ACA, Mountain Health Cooperative.

Nebraska

Overall market: Two insurers, Medica and Aetna, will participate in Nebraska's federally-facilitated marketplace in 2017. UnitedHealthcare and Blue Cross and Blue Shield of Nebraska will exit the state's exchange at the end of the year. 

Average rate increases: The Nebraska Department of Insurance approved the following rate increases for two insurers for individual plans offered on the state's 2017 exchange:

  • Medica (53 percent)
  • Aetna (30.5 percent)

Medicaid: Nebraska has not expanded Medicaid under the ACA. Lawmakers have tried three times to expand Medicaid coverage in Nebraska. Lawmakers disclosed a new plan to cover the state's Medicaid coverage gap population in January. The potential bill would cover approximately 77,000 adults without children.

Co-op: CoOportunity, a health cooperative created under the ACA, was taken over by the state in late December 2014. Officials found the nonprofit's medical claims would exceed its available cash. The closure affected 120,000 policyholders in Nebraska and Iowa.

Nevada

Overall market: Nevada's state-run exchange, Nevada Health Link, will have three insurers offering individual plans next year, though residents of some counties will not have three insurers to choose from. Ten out of the state's sixteen counties are projected to only have one insurer participating on the state's exchange as of late August. Four counties are projected to have two insurers and three counties are projected to have three or more insurers, including Clark County, housing the state's highest projected enrollment. 

Average rate increases: The following are average approved premium rate increases for individual plans from insurers offering plans on Nevada Health Link next year:

  • Health Plan of Nevada, or UnitedHealthcare's HMO (8 percent)
  • Prominence HealthFirst (17 percent)
  • Anthem Blue Cross and Blue Shield, or HMO Colorado/HMO Nevada (7.9 percent)
  • Anthem BCBS, also called Rocky Mountain Hospital and Medical Service (12 percent)

Medicaid: Nevada Health Link enrolled 182,946 applicants in the state's Medicaid program as of April, which was expanded under the ACA.

Co-op: Nevada Health CO-OP closed Jan. 1 due to challenging market conditions. The insurer said the growth needed to provide health plans at reasonable rates would not be likely in 2016.  

New Hampshire

Overall market: New Hampshire's state-partnership marketplace (in partnership with the federal government) is projected to have at least three insurers offering ACA plans in all counties next year. Sixty-seven percent of New Hampshire residents eligible for subsides are enrolled in health plans through the ACA.  

Average rate increases: Insurers requested varying rate increases on individual ACA exchange plans, from about 1 percent to almost 60 percent. The following are average premium rate increases proposed for individual health plans on New Hampshire's public exchange:

  • Celtic Insurance (1.4 percent)
  • Harvard Pilgrim Health Care of New England (5.5 percent)
  • Minuteman Health (30.7 percent)

Medicaid: New Hampshire expanded Medicaid under the ACA effective January 2014.

Co-op: Community Health Options will pull out of New Hampshire's health insurance market next year to concentrate on its Maine market. The co-op is preparing for a total $43 million loss this year.  

New Jersey

Overall market: In all New Jersey counties, at least two insurers are projected to offer plans on the state's federally-facilitated marketplace next year. UnitedHealthcare, Oscar Health and co-op Health Republic of New Jersey will not offer plans on the exchange next year, and Aetna retracted its plans to enter the market. Seventy-seven percent of marketplace enrollees eligible for subsidies in New Jersey are enrolled.

Average rate increases: The following average rate increases for individual plans on the state's public exchange were proposed:

  • AmeriHealth Insurance (19.2 percent)
  • Horizon Blue Cross Blue Shield of New Jersey (4.4 percent)

Medicaid: New Jersey expanded Medicaid under the ACA, effective January 2014. New Jersey Gov. Chris Christie (R) said in August the state's Medicaid expansion allowed more than half a million residents to obtain health insurance.

Co-op: Nonprofit insurance co-op Health Republic of New Jersey exited the exchange marketplace in early September, forcing 35,000 policyholders to find new plans in 2017. The insurer owes $46.3 million in risk adjustment payments to the federal government. Health Republic of New Jersey is the 17th insurance co-op to fold under the ACA. Only six insurance co-ops remain operational of the original 23.

New Mexico

Overall market: One insurer, Presbyterian Health Plan, will drop out of New Mexico's exchange Dec. 31. The change affects nearly 10,000 New Mexico residents who received federal subsidies to buy insurance from Presbyterian on the federal exchange. The insurance plan is expected to lose about $23 million on its individual plans this year. Blue Cross and Blue Shield of New Mexico will reenter the state's exchange after not participating in 2016. Fifty-six percent of enrollees eligible for subsides were enrolled as of March, according to the Kaiser Family Foundation.

Average rate increases: The following average approved rate increases for 2017 are from the four insurers offering individual plans on the state's ACA exchange:

  • Blue Cross and Blue Shield of New Mexico (91.8 percent)
  • New Mexico Health Connections (34 percent)
  • Molina Healthcare (23.9 percent)
  • Christus (12.6 percent)

Medicaid: New Mexico expanded its Medicaid program effective January 2014.

Co-op: New Mexico Health Connections is one of six remaining health insurer cooperatives created under the ACA. The co-op sued the federal government in August  for allegedly mismanaging the ACA's risk adjustment program, under which the insurer owes $14.6 million.

New York

Overall market: As of Aug. 28, 95 percent of New York's state-based marketplace is expected to have three or more health insurers to choose from in the next open enrollment period. Chemung, Tompkins and Schuyler counties are projected to have two insurers. WellCare is exiting the exchange — called New York State of Health — for 2017. In total, 14 insurers will offer individual health plans through New York State of Health. On average, on-exchange individual plans will increase premiums 16.6 percent next year.

Average rate increases: The following are average approved rate increases for individual plans on New York's 2017 public exchange:

  • Affinity Health Plan (22.4 percent)
  • Capital District Physicians' Health Plan (13.9 percent)
  • Empire HealthChoice HMO (15.2 percent)
  • Excellus Health Plan (15.4 percent)
  • Health Insurance Plan of Greater New York (13.9 percent)
  • Healthfirst PHSP (7.4 percent)
  • HealthNow New York (8.7 percent)
  • Independent Health Benefits (19.6 percent)
  • Metro Plus Health Plan (29.2 percent)
  • MVP Health Plan (6 percent)
  • Fidelis Care New York (11.6 percent)
  • North Shore-LIJ CareConnect Insurance (29.2 percent)
  • Oscar (19.6 percent)
  • UnitedHealthcare of New York (28 percent)

Medicaid: New York expanded Medicaid under the ACA.

Co-op: Health Republic of New York, an ACA-created co-op, was terminated in September 2015. The insurer was ordered to cease operations after regulators determined it was likely to become financially insolvent.

North Carolina

Overall Market: Next year, 90 percent of North Carolina counties are projected to only have one insurer offering individual plans on the state's federally-facilitated marketplace, including its most populous county, Mecklenburg. The other 10 percent, including the state's second most populous county, Wake, are projected to have two insurers offering individual plans on the exchange. UnitedHealthcare and Aetna will exit the state's exchange. Cigna will enter, and Blue Cross and Blue Shield of North Carolina will stay in the market. In June, BCBS of North Carolina sued the federal government, claiming the U.S. failed to pay the insurer $147 million in payments owed under the ACA's risk corridor program. In September, the North Carolina Department of Insurance issued a $3.6 million fine against BCBS of North Carolina for chronic IT malfunctions that have led to billing and enrollment errors for customers since January. The insurer reported a $282 million loss on plans sold on the ACA exchange in 2015 and increased rates by 32.5 percent for 2016 and has requested to raise rates for 2017.

Average rate increases: The following are average requested rate increases for the two insurers offering individual plans on the exchange for 2017:       

  • BCBS of North Carolina (19 percent)
  • Cigna (new to market)

Medicaid: North Carolina did not expand Medicaid under the ACA.

North Dakota

Overall market: Three insurers will offer individual health plans on North Dakota's federally-facilitated marketplace for 2017. As of August, 92 percent of counties in North Dakota will have three insurers to choose from in the next enrollment period. Blue Cross Blue Shield of North Dakota has the majority of the exchange's enrollment, so its small rate decrease means the overall average rate increase in North Dakota could be much lower than the national average for 2017.

Average rate: The following rate changes were approved for 2017:

  • Blue Cross Blue Shield of North Dakota (1.6 percent decrease)
  • Medica (13.8 percent increase)
  • Sanford Health Plan (7.9 percent increase)

Medicaid: North Dakota expanded Medicaid under the ACA.

Ohio

Overall market: Ohio's federally-facilitated marketplace will have 10 insurers offering individual plans. InHealth Mutual, Aetna and All Savers, a subsidiary of UnitedHealthcare, will exit the market in 2017. CareSource will absorb about 40,000 displaced policyholders following other insurers' exits. As of August, 94 percent of Ohio counties are projected to have three or more insurers offering individual health plans on the exchange for 2017.

Average rate changes: Ten insurers have requested the following average premium rate changes for 2017 for individual plans offered on the exchange:

  • AultCare (24.1 percent increase)       
  • Buckeye Community Health Plan (0.97 percent decrease)
  • CareSource (13. 4 percent)
  • Community Insurance, or Anthem BCBS (10.8 percent increase)
  • Humana (39.3 percent increase)
  • Medical Health Insuring of Ohio, or Medical Mutual (17.1 percent decrease)
  • Molina (2.4 percent increase)
  • Paramount (9.9 percent increase)
  • Premier Health Plan (39.8 percent increase)
  • Summa (5.6 percent increase)

Medicaid: Ohio expanded Medicaid under the ACA.

Co-op: InHealth Mutual, a struggling health insurance co-op providing coverage to nearly 22,000 Ohioans, was taken over by the state in May. The federal government ramped up oversight of the co-op in fall 2015 after it reported a $9.1 million loss for the first six months of fiscal year 2015.

Oklahoma

Overall market: Oklahoma's federally-facilitated exchange will only have one insurer offering on-exchange, individual plans in all counties next year. UnitedHealthcare will exit the individual exchange next year. The state's sole insurer, Blue Cross and Blue Shield of Oklahoma, holds 95 percent of the individual market.

Average rate increase: Oklahoma's sole ACA insurer requested the following average premium rate increase for its on-exchange, individual plans:

  • Blue Cross and Blue Shield of Oklahoma (76 percent)

Medicaid: Oklahoma has not expanded Medicaid under the ACA. In May, the state said it was considering Medicaid expansion after years of resistance due to a $1.3 billion budget deficit caused by low oil prices and overspending. If Oklahoma expands Medicaid, the state could move 175,000 women and children into subsidized coverage while opening Medicaid to 628,000 working-age adults, according to Forbes.

Oregon

Overall market: Seven insurers will offer on-exchange, individual plans for 2017 on Oregon's federally-facilitated, state-based marketplace. The marketplace is projected to have three or more insurers offering on-exchange, individual plans for 2017 in all 36 counties. Oregon Health CO-OP and LifeWise Health Plan of Oregon will exit the market next year. Moda Health Plan, PacificSource and Providence Health Plan will reduce their statewide coverage to select counties. Ninety percent of Oregon residents eligible for subsidies under the ACA have enrolled in plans as of March 2016.

Average rate increases: These are the average requested rate increases for the seven insurers offering on-exchange, individual plans next year:

  • Atrio Health Plans (14.9 percent)
  • BridgeSpan (18.8 percent)  
  • Kaiser Permanente (14.9 percent)
  • Moda Health Plan (24.7 percent)
  • PacificSource (15.2 percent)
  • Providence Health Plan (29.6 percent)
  • Zoom+ Performance Health Plan (27.3 percent)

Medicaid: Oregon expanded Medicaid under the ACA.

Co-op: Oregon's Health CO-OP went into receivership status in July and will close — leaving 23,000 uninsured — in light of $900,000 it owes under the ACA's risk corridor program and its high medical loss ratio.

Pennsylvania

Overall market: The Pennsylvania Insurance Department said premium rates for individual ACA plans will increase an average 32.5 percent next year. UnitedHealthcare will exit the market. Seventy-five percent of Pennsylvania residents who purchase ACA health plans receive subsidies to offset costs.

Average rate increases: The following seven insurers were approved these average premium rate increases for on-exchange, individual plans next year:

  • Capital Advantage Assurance (43.3 percent)
  • Keystone Health Plan Central (32.4 percent)
  • Highmark (50.2 percent)
  • Geisinger Health Plan (42.1 percent)
  • Keystone Health Plan East (28 percent)
  • Independence Blue Cross (28.4 percent)
  • UPMC Health Coverage (17.9 percent)

Medicaid: Pennsylvania expanded Medicaid under the ACA effective January 2015.

Rhode Island

Overall market: Rhode Island's state-based marketplace, HealthSourceRI, is expected to have two insurers offering plans in all of the state's five counties next year. UnitedHealthcare will exit the state's marketplace in 2017. The two remaining insurers — Blue Cross & Blue Shield of Rhode Island and Neighborhood Health Plan of Rhode Island — hold the majority of the state's individual market. Sixty-three percent of residents eligible for subsidies through the ACA are enrolled.

Average rate changes: The two insurers offering on-exchange, individual health plans have been approved to implement the following average rate changes for 2017:

  • Blue Cross & Blue Shield of Rhode Island (5.6 percent increase)
  • Neighborhood Health Plan of Rhode Island (5.9 percent decrease)

Medicaid: Rhode Island adopted Medicaid expansion under the ACA.

South Carolina

Overall market: Only one insurer is projected to offer on-exchange, individual health plans on South Carolina's federally-facilitated marketplace next year. UnitedHealthcare and Aetna will exit the market at the end of the year. Sixty-two percent of individuals eligible for subsidies under the ACA are enrolled.

Average rate increase: South Carolina's sole insurer offering on-exchange, individual health plans next year requested the following average premium rate increase:

  • BlueCross BlueShield of South Carolina (14.5 percent)

Medicaid: South Carolina has not expanded Medicaid under the ACA.

Co-op: Consumers' Choice Health Plan shuttered at the end of 2015, leaving 67,000 members to look for new health plans.

South Dakota

Overall market: South Dakota's 66 counties are each projected to have two insurers offering on-exchange, individual health plans for 2017. Forty-one percent of individuals eligible for subsidies under the ACA are enrolled in health plans through South Dakota's federally-facilitated marketplace.

Average rate increases: The following average premium rate increases were approved for the two insurers offering on-exchange, individual health plans for 2017:

  • Avera Health Plans (38.2 percent)
  • Sanford Health Plan (36.3 percent)

Medicaid: South Dakota has not expanded Medicaid under the ACA.

Tennessee

Overall market: BlueCross BlueShield of Tennessee will pull back its ACA footprint in three of Tennessee's most populous regions for 2017, affecting 100,000 members across the state. BCBST cited $500 million in losses on ACA plans over the past three years. UnitedHealthcare will not participate in the 2017 exchange. Tennessee's Insurance Commissioner Julie McPeak said in August the state's exchange may collapse after insurance regulators approved major rate hikes for insurers. Sixty-six percent of the state's population that is eligible for subsidies under the ACA have enrolled in health plans through the exchange.

Average rate increases: The following average premium rate increases were approved for the three insurers offering on-exchange, individual health plans for 2017:

  • BlueCross BlueShield of Tennessee (54.6 percent)
  • Cigna (47.9 percent)
  • Humana (44.3 percent)

Medicaid: Tennessee has not adopted Medicaid expansion under the ACA. However, the Tennessee state legislature released a new proposal for Medicaid expansion in July.

Co-op: Community Health Alliance, Tennessee's health cooperative created under the ACA, closed two weeks before open enrollment in 2016.

Texas

Overall market: UnitedHealthcare, Aetna and Scott & White Health plan will exit Texas' ACA exchange in 2017. Cigna is considering leaving the market as well. Thirty percent of Texas counties are projected to only have one insurer offering on-exchange, individual health plans next year. Fifty-one percent of counties are predicted to have two insurers and 15 percent are predicted to have at least three. As of September, 13 insurers will offer on-exchange, individual plans next year. Fifty-one percent of Texas' eligible population for subsidies under the ACA have enrolled through the state's federally-facilitated marketplace.

Average rate increases: The following are the average requested premium rate increases for the 13 insurers offering on-exchange, individual health plans for 2017 :

  • Allegian (27.5 percent)
  • Blue Cross and Blue Shield of Texas (58.4 percent)
  • Celtic, or AmBetter (15.6 percent)
  • CHRISTUS Health (26.8 percent)    
  • Cigna (23.5 percent)  
  • Community First (8.1 percent)
  • Community Health Choice (6.9 percent)
  • FirstCare, or SHA (29.1 percent)
  • Humana (45.4 percent)          
  • IdealCare, or Sendero Health Plans (19.7 percent)                                       
  • Molina (10.3 percent)                                     
  • Oscar Insurance Company of Texas (17.3 percent)
  • Prominence HealthFirst (31.9 percent)

Medicaid: Texas has not expanded Medicaid under the ACA.

Utah

Overall market: Humana will exit Utah's federally-facilitated marketplace next year. Sixty-nine percent of counties in Utah are projected to only have one insurer offering on-exchange, individual plans next year. Seven percent of the state's counties are projected to have two insurers and 24 percent are predicted to have at least three. Seventy-nine percent of individuals eligible for subsidies under the ACA were enrolled in health plans via the public exchange as of March 2016.

Average rate increase: Three insurers were approved the following average premium increases for on-exchange, individual health plans for 2017:

  • Molina Healthcare (37.1 percent)
  • SelectHealth (30.6 percent)   
  • University of Utah Health Plans (4.5 percent)

Medicaid: Utah has not expanded Medicaid under the ACA.

Co-op: Arches Health Plan, Utah's health insurance co-op, stopped offering coverage as of Dec. 31, 2015. The co-op insured 66,000 Utahans. It did not receive any of the $8.7 million it expected from the federal government in risk corridor payments.

Vermont

Overall market: All of Vermont's 14 counties are projected to have two insurers offering individual health plans on its state-based marketplace, Vermont Health Connect. The exchange has struggled with IT problems since its onset, most of which have been resolved. Vermont is one of only two states to merge its individual and small group risk pools. Fifty-six percent of individuals eligible for subsidies under the ACA have enrolled in health plans through Vermont Health Connect as of March 2016.

Average rate increases: The following average rate increases for the two insurers offering on-exchange, individual and small group health plans on Vermont Health Connect have been approved for 2017:

  • BlueCross BlueShield of Vermont (7.9 percent)
  • MVP Health Plan (3.7 percent)

Medicaid: Vermont expanded Medicaid under the ACA.

Virginia

Overall market: Cigna is predicted to join Virginia's federally-facilitated marketplace next year. Coventry is leaving the exchange. Aetna purchased Coventry in 2013, and Aetna is expected to offer plans on the exchange next year. Twenty-two percent of Virginia's counties are projected to only have one insurer offering on-exchange, individual health plans next year. Twenty-eight percent of the state's counties are projected to have two insurers, and half are projected to have three or more insurers offering on-exchange, individual health plans.

Average rate increases: The following nine insurers requested these average premium rate increases for on-exchange, individual plans for 2017:

  • CareFirst BlueChoice (25.3 percent)
  • Cigna (new to market)
  • Group Hospitalization and Medical Services (25.9 percent)
  • Health Keepers (14.9 percent)
  • Innovation Health Insurance (14.4 percent)
  • Kaiser Foundation Health Plan of the Mid-Atlantic (6.7 percent)
  • Optima Health Plan (39.3 percent)
  • Piedmont Community Healthcare (15.3 percent)
  • UnitedHealthcare of the Mid-Atlantic (9.4 percent)

Medicaid: Virginia has not expanded Medicaid under the ACA. Virginia Gov. Terry McAuliffe (D) vetoed language in May that Republican lawmakers included in the state budget earlier in the year that would prevent him from expanding Medicaid without legislative approval.

Washington

Overall market: UnitedHealthcare is exiting Washington's state-based exchange, Washington Healthplanfinder, in 2017. Fifty-nine percent of counties in Washington are projected to have at least three insurers offering on-exchange, individual health plans in 2017. Twenty-eight percent of the state's counties are predicted to have two insurers participating on the state's exchange next year and 13 percent will only have one participating insurer. Thirty-six percent of residents eligible for subsidies under the ACA have enrolled in health plans through the state's exchange.

Average rate increases: Seven insurers were approved to offer on-exchange, individual health plans on Washington Healthplanfinder for 2017. The following are their average premium rate increases requested:

  • Community Health Plan of Washington (11.3 percent)
  • Coordinated Care (7.4 percent)
  • Group Health Cooperative (9.5 percent)
  • Kaiser Foundation Health Plan of the Northwest (10.3 percent)
  • LifeWise (10.9 percent)
  • Molina Healthcare of Washington (9.6 percent)
  • Premera Blue Cross (20 percent)

Medicaid: Washington expanded Medicaid under the ACA.

West Virginia

Overall market: Eighty-two percent of West Virginia's counties are projected have one insurer offering on-exchange, individual health plans in 2017. The remaining counties will have two insurers. Forty-one percent of residents eligible for subsidies under the ACA enrolled in plans through the state's exchange as of March 2016.

Average rate increases: Two insurers offering health plans on the state's individual exchange requested the following average premium increases for 2017:

  • CareSource (35.8 percent)
  • Highmark Blue Cross Blue Shield (31.8 percent)

Medicaid: West Virginia expanded Medicaid under the ACA.

Wisconsin

Overall market: UnitedHealthcare will exit Wisconsin's federally-facilitated marketplace next year. About three-fourths of the state's counties (76 percent) are projected to have at least three insurers offering on-exchange, individual health plans next year. Eighteen percent of counties are projected to have two insurers and four counties are projected to only have one insurer. Milwaukee-based Children's Hospital and Health System will sell its Children's Community Health Plan through the ACA marketplace next year. Sixty-three percent of residents eligible for subsidies under the ACA have enrolled in health plans through the state's exchange.

Average rate changes: These insurers were approved the following average premium changes for next year:

  • Children's Community Health Plan (new to market)
  • Common Ground Healthcare Cooperative (26.9 percent increase)
  • Anthem Blue Cross Blue Shield, or Comp-Care (21.7 percent increase)
  • Dean Health Plan (18.6 percent increase)
  • Group Health Cooperative (5.4 percent increase)
  • Gundersen Health Plan (18.2 percent increase)
  • Health Tradition Health Plan (24.4 percent increase)
  • Medica Health Plans (11.5 percent increase)
  • MercyCare (13.1 percent decrease)
  • Molina Healthcare (27 percent increase)
  • Network Health Plan (20.1 percent increase)
  • Security Health Plan (15.6 percent increase)
  • United Health Plans (31.9 percent increase)
  • WPS Health Plan (12.3 percent increase)

Medicaid: Wisconsin has not expanded Medicaid under the ACA.

Co-op: Common Ground Healthcare Cooperative is one of six remaining health cooperatives established under the ACA. The co-op, which insures about 20,000, lost $43.2 million last year. Despite the challenges, Common Ground's CEO Cathy Mahaffey said in July she is confident the insurer will break even and exist through the end of the year.

Wyoming

Overall market:Wyoming's federally-facilitated marketplace will only have one insurer offering on-exchange, individual health plans in all of the state's counties next year. Forty-eight percent of residents eligible for subsidies under the ACA enrolled in health plans through the state's exchange.

Average rate increase: The only insurer offering on-exchange, individual health plans for 2017 requested the following average premium rate increase:

  • Blue Cross Blue Shield of Wyoming (8 percent)

Medicaid: Wyoming has not expanded Medicaid under the ACA. State lawmakers rejected Gov. Matt Mead's (R) proposal for Medicaid expansion in January. 

Correction: In Kentucky, former Gov. Steve Beshear (D) expanded Medicaid in 2013, not current Gov. Matt Bevin (R). We regret this error. 

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