Marketplace Pulse: On the Eve of Big Changes, What is the Status of ACA Marketplace Participation?

The Marketplace Pulse series provides expert insights on timely policy topics related to the health insurance marketplaces. The series, authored by RWJF Senior Policy Adviser Katherine Hempstead, analyzes changes in the individual market; shifting carrier trends; nationwide insurance data; and more to help states, researchers, and policymakers better understand the pulse of the marketplace.

In recent years, marketplace participation has not changed dramatically, but there are already indications that 2026 may be quite different, with Aetna's exit and some recently announced reductions in Colorado offerings by United Health Group and Elevance. (United Health Group and Elevance recently announced that they had discontinued the planned reductions in offerings in Colorado).

The Marketplace Participation Tracker shows the current state of participation on the eve of a plan year where large increases in premiums and reductions in enrollment are expected, along with perhaps some additional reductions in participation. The projected enrollment decline among subsidized members may or may not be offset to some degree by increased enrollment from employer groups via ICHRAs, which is expected to largely take place in the off-exchange.

The tracker is an interactive, county-level map that allows users to explore participation trends both off and on exchange by geography, insurer type, parent company, and consumer brand name. The data can be downloaded. (The tracker measures participation rather than the number of individual plans).

Here are a few top-level takeaways:

1. Participation changed little in 2025

Nationally, the number of on-exchange offerings increased by 3%, the smallest increase since 2018. The number of off-exchange offerings increased by 8%.

2. Geographical patterns were different for on- and off-exchange offerings

In terms of geographical patterns, eight states lost on-exchange offerings in 2025 (NM, ME, TX, KY, WI, VA, UT, and NY), 13 states saw no change, and only 11 states had increases of 10% or more. These were largely, but not exclusively, rural western or midwestern states such as Wyoming, Iowa, Nebraska, and Oklahoma.

In terms of off-exchange plans, eight states currently have none, and 14 states lost offerings. Twelve states saw no change, and only 18 states had increased offerings. But some of those increases were large. For example, seven states had a more than 50% increase in the off-exchange offerings. Most, but not all, are east coast states in the south or New England (SC, VA, ND, IN, RI, NC, and MA).

3. Increases in offerings were driven by national insurers

National insurers modestly increased their share of individual market offerings. The proportion of on-exchange offerings from national carriers increased from 51% to 53%, and their share of off-exchange offerings increased from 40% to 45%. 

4. County coverage

The median county has three or four on-exchange offerings, but there are 72 counties that have only one. They are in Alaska, Alabama, Arizona, Colorado, Illinois, Kentucky, Texas, and Utah.