What Characterizes the Marketplaces with One or Two Insurers?

 A line of waiting patients in a clinic.

Analysis finds the more health insurers in a region, the lower the premiums.



The Issue

Urban Institute researchers find that marketplace health insurance premium levels and premium growth directly correlate with the number of insurers participating in a given rating region. Regions with one or two insurers tend to be sparsely populated, and heavily concentrated in southern states.

Key Findings

  • Median monthly benchmark premiums range from $270 in markets with six or more insurers to $451 in markets with just one insurer in 2017.

  • In regions with six or more insurers, the median 2017 benchmark premium increase was 5.0 percent compared to 29.8 percent in regions with only one insurer.

  • Markets with only one or two insurers tend to be heavily concentrated in southern states and sparsely populated areas.


Researchers compared the number of insurers participating in each of the 498 premium rating regions across the country, their benchmark premiums—or the cost for their second-lowest-cost silver plan—and the populations of these regions, according to the U.S. Census Bureau’s estimates for 2014.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.