How Has Insurer Participation in the ACA Marketplaces Changed in 2026?
For the first time since the enhanced premium tax credits were introduced in 2021, insurer participation in the ACA Marketplaces has gone down. This drop follows the expiration of the enhanced premium tax credits at the end of 2025 and is primarily driven by the exit of Aetna CVS from 17 states as well as exits from other insurers. While the average number of insurers per state offering plans in the Marketplaces in 2026 is lower than in the years after the enhanced premium tax credits were established, more insurers are now offering plans than were before the enhanced tax credits.
Key Findings:
The average number of issuers offering plans in the ACA Marketplaces has declined from a record high of 9.6 issuers per state in 2025 to 9.0 issuers per state in 2026.
In total, 18 states experienced a net decrease in the number of issuers offering ACA Marketplace plans.
Three in 10 counties have fewer participating ACA insurers than last year. In 165 counties, only one issuer is offering plans on the ACA Marketplace, up from 93 counties in 2025.
National Level
Nationally, average insurer participation in the ACA Marketplaces has decreased from the record high of 9.6 insurers per state in 2025 to 9.0 insurers per state in 2026. This decrease follows the nationwide departure of CVS from the Exchanges and marks the first time since 2018 that the average number of insurers in the ACA Marketplaces has gone down. Insurer participation on the ACA Marketplaces fell in 2017 with the exit of UnitedHealthcare from most states. In 2018, following several attempts to repeal the ACA in Congress as well as changes to enforcement of the individual mandate and payments for cost-sharing reductions, many more insurers exited or scaled back their participation. As the Marketplace stabilized in the following years, participation in the ACA Marketplaces steadily grew with some insurers returning to the Marketplace and several others expanding their footprints.
State Level
The most prominent insurer in the Marketplace is UnitedHealth, which offers Marketplace plans in 30 states. Some of the other major players currently in the Marketplace include Centene Corporation (29 states), Oscar Health (20 states), Elevance Health (18 states), Molina Healthcare (14 states), Cigna Health (11 states), and Kaiser (10 states). CVS, which ran Aetna plans in the ACA Marketplaces, was a significant insurer participating in the ACA Marketplaces in 2025. Before leaving the Marketplace for plan year 2026, CVS Aetna offered plans in 17 states.
Some of the aforementioned insurers are among those with the largest number of enrollees in the individual market (the vast majority of which is made up of people in the Marketplace in 2025). For example, in 2024, 18% of people in the individual market were enrolled in a plan offered by the Centene Corporation and 8% of individual market enrollees were in a plan offered by CVS.
County Level
Even if an insurer remains in a state, it may significantly change its footprint from year to year. Insurers adjust their footprints by expanding into some counties or withdrawing from others. For example, UnitedHealth scaled back its footprint in Kansas from 87% of counties in 2025 to 33% in 2026, and in South Carolina from 72% of counties in 2025 to 37% in 2026. However, it also expanded its service area in Oklahoma, offering plans in 74% of counties in 2026, up from 18% in 2025. Another major player in the ACA Marketplaces, Centene Corporation, went from offering plans in all counties in North Carolina in 2025 to 63% of counties in 2026. This decrease is driven by the exit of WellCare (a subsidiary of Centene) from the North Carolina Marketplace starting in 2026. In Iowa, Centene’s footprint increased from 33% to 59% of its counties going from 2025 to 2026.