Insurer participation in the ACA Marketplaces has dropped for the first time since the enhanced premium tax credits were introduced in 2021. According to KFF, the decrease comes following the expiration of 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," according to a new report from the independent nonprofit health research and polling organization.
Using the Qualified Health Plan Individual Medical Landscape File and Robert Wood Johnson Foundation (RWJF) HIX Compare file, KFF researchers determined the number of insurers participating in states using the federal platform and state-based Exchanges. They found that 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.
All told, 18 states experienced a net decrease in the number of issuers offering ACA Marketplace plans. More granular, 3 in 10 counties have fewer participating ACA insurers than last year; in 165 counties, only one issuer is offering plans on the ACA Marketplace; in 2025, 93 counties had only one issuer offering plans.
According to KFF: "One factor that contributes to the number of insurers participating in the Marketplaces is the number of people with coverage. After the introduction of the enhanced premium tax credits in 2021, enrollment in the Marketplaces reached new records. In line with this trend, the number of insurers offering plans in the ACA Marketplaces increased significantly in 2022.
Data shows that after the expiration of the enhanced premium tax credits, 2026 Open Enrollment Period sign-ups declined by over one million people relative to last year; and the number of people who pay to maintain and "effectuate" their coverage will likely decline throughout the year. KFF estimates that average effectuated enrollment in the Marketplaces could decline by about five million from 2025 to 2026."
The five states with the most insurers offering plans in their ACA Marketplaces in 2026 are Texas (15), New York (12), California (11), Florida (11), and Wisconsin (11). Four states (Alabama, Iowa, Louisiana, and Washington) experienced a net increase of one insurer.
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