PATIENT 

PROTECTION AND 

AFFORDABLE CARE 

ACT

Largest Issuers of 

Health Coverage 

Participated in Most 

Exchanges, and 

Number of Plans 

Available Varied

Report to Congressional Requesters

August 2014

GAO-14-657

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-14-657, a report to 

congressional requesters

August 2014

PATIENT PROTECTION AND AFFORDABLE 

CARE ACT 

Largest Issuers of Health Coverage Participated in 

Most Exchanges, and Number of Plans Available 

Varied

Why GAO Did This Study

PPACA required by January 1, 2014, 

the establishment in each state of 

health insurance exchanges—

marketplaces where eligible individuals 

and small businesses can compare 

and select among insurance plans. 

Issuer participation, including the 

number of plans these issuers offer, is 

a key factor in the extent of consumer 

choice offered by the exchanges.

GAO was asked to examine the 

number and types of issuers 

participating in both the individual and 

small-business exchanges beginning in 

2014, as well as how this compared 

with issuer participation in the 

individual and small-group markets 

prior to the exchanges. In this report, 

GAO describes (1) the extent to which 

issuers that previously offered health 

plans in the individual and small-group 

markets participated in the exchanges 

in 2014, and (2) the issuers that 

participated in 2014 exchanges and 

the health plans they offered.

GAO analyzed data obtained from 

CMS and states on the health plans 

offered by issuers that participated in 

states’ exchanges in 2014. GAO also 

analyzed CMS data on issuers’ 

participation and market share in the 

2012 individual and small-group 

markets, the most recently available 

national market-wide data. GAO 

reviewed relevant laws and regulations 

and interviewed CMS officials to 

identify federal requirements related to 

exchange participation. GAO obtained

information on state participation 

requirements from applicable states.

What GAO Found

Most of the largest issuers of health coverage from 2012 participated in the 

exchanges that the Patient Protection and Affordable Care Act (PPACA) required 

be established in all states in 2014. Previously, in 2012, while a large number of 

issuers participated in state individual and small-group markets, a small number 

of these participating issuers held a majority of the market share in terms of 

enrollment. In 2014, for both those exchanges serving the individual market and 

those serving the small-group market, in more than two-thirds of states the issuer 

with the largest share of the 2012 market participated in the 2014 exchange. In 

addition, in most states, other larger issuers with a 5 percent or more share of the 

2012 market participated in the 2014 exchanges. Most smaller issuers with less 

than 5 percent of the 2012 market did not participate in the 2014 exchanges, 

although in many states more than one of these smaller issuers did participate. In 

addition, some issuers that participated in a 2014 individual or small-business 

exchange had not offered coverage in the respective 2012 market, although they 

may have offered coverage in other markets within the same state. In most 

states, for 2014, the issuers participating in the exchanges represented a mix of

larger issuers, smaller issuers, and issuers new to that market.

Table: Average Issuer Participation in 2014 Exchanges across States

Type of exchange 

Average number of 

participating issuers 

Average number of 

issuers new to the 

market in 2014

Average 2012 market 

share of all 

participating issuers

Individual 6 3 57

Small-business 4 1 56

Source: Centers for Medicare & Medicaid Services (CMS) and states. | GAO-14-657

Multiple issuers participated in nearly all 2014 exchanges and generally offered 

more health plans than the minimum of two required by PPACA. Overall, the 

number of participating issuers varied widely between states, from 1 to 17 

issuers in the individual exchanges and from 1 to 13 issuers in the smallbusiness exchanges. However, almost all exchanges—49 individual and 45 

small-business—had more than one issuer participating. More than half of 

participating issuers offered coverage through both the individual and smallbusiness exchange in that state, although more issuers participated in the 

individual exchanges than in the small-business exchanges. Issuers varied 

substantially in the number of plans they offered; 257 of the 291 issuers in the 

individual exchanges, and 183 of the 207 issuers in the small-business 

exchanges, offered more than the minimum number of plans required by PPACA 

in all the rating areas in which they offered coverage. For both the individual and 

small-business exchanges, collectively, issuers in the 25 most populous states 

tended to offer a higher than average number of plans, while those in less 

populous states were less likely to do so.

GAO received technical comments on a draft of this report from the Department 

of Health and Human Services and incorporated them as appropriate.

View GAO-14-657. For more information, 

contact John Dicken at (202) 512-7114 or 

dickenj@gao.gov.
Page i GAO-14-657 Issuer Participation in Health Insurance Exchanges

Letter 1

Background 5

Most of the Largest Issuers in the 2012 Individual and Small-group 

Markets Participated in the 2014 Exchanges, with Exceptions in 

Some States 9

Nearly All 2014 Exchanges Had Multiple Participating Issuers, 

Which Generally Offered More Plans than the Minimum 

Required by PPACA 14

Agency Comments 23

Appendix I Issuers’ Participation in the 2014 Exchanges and Their 2012 Market 

Share 24

Appendix II Number of Issuers Participating in the 2014 Individual and Smallbusiness Exchanges, by State 28

Appendix III Number of Plans Offered by Issuers Participating in the 2014 

Exchanges across Rating Areas 30

Appendix IV Number of Plans Offered by Issuers in 2014 Individual and Smallbusiness Exchanges 32

Appendix V GAO Contact and Staff Acknowledgments 34

Tables

Table 1: State-Based Exchanges with Requirements Related to 

Issuer Participation 9

Table 2: Number of Plans Offered by Issuers Participating in the 

2014 Exchanges across Rating Areas 17

Table 3: 2012 Market Share of Issuers Participating in the 2014 

Individual Exchanges, by State 24

Contents
Page ii GAO-14-657 Issuer Participation in Health Insurance Exchanges

Table 4: 2012 Market Share of Issuers Participating in the 2014 

Small-business Exchanges, by State 26

Table 5: Number of Issuers Participating in the 2014 Exchanges, 

by State 28

Table 6: Number of Plans Offered by Issuers Participating in the 

2014 Exchanges across Rating Areas 30

Table 7: Number of Plans Offered by Issuers in the 2014 

Exchanges, by State 32

Figures

Figure 1: Health Insurance Exchange Arrangements for 2014 6

Figure 2: Issuer Participation in State Individual and Small-group 

Markets in 2012 10

Figure 3: Issuers Participating in the 2014 Exchanges across All 

States, by Category of Market Share in 2012 13

Figure 4: Number of Issuers Participating in the 2014 Individual 

and Small-business Exchanges, by State 15

Figure 5: Average Number of Plans Issuers Offered in the 2014 

Individual and Small-Business Exchanges, By State 19

Figure 6: Number of Plans Available in Each 2014 Individual 

Exchange, by State Population Category 21

Figure 7: Number of Plans Available in Each 2014 Small-business 

Exchange, by State Population Category 22

Abbreviations

CMS Centers for Medicare & Medicaid Services

CO-OP Consumer Oriented and Operated Plans

OPM Office of Personnel Management

PPACA Patient Protection and Affordable Care Act

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Page 1 GAO-14-657 Issuer Participation in Health Insurance Exchanges

441 G St. N.W.

Washington, DC 20548

August 29, 2014

The Honorable Orrin G. Hatch

Ranking Member

Committee on Finance

United States Senate

The Honorable Tom Coburn, M.D.

Ranking Member

Committee on Homeland Security and Government Affairs

United States Senate

The Patient Protection and Affordable Care Act (PPACA) required, by 

January 1, 2014, the establishment in each state of health insurance 

exchanges—marketplaces where eligible individuals and small 

businesses can compare and select among health plans.1 PPACA does 

not require issuers of health coverage to offer plans through these 

exchanges but, instead, generally relies on market incentives to 

encourage their participation.2

 1

Pub. L. No. 111-148, §§ 1311(b), 1321(c), 124 Stat. 119, 173, 186 (Mar. 23, 2010) 

(hereafter, “PPACA”), as amended by the Health Care and Education Reconciliation Act of 

2010, Pub. L. No. 111-152, 124 Stat. 1029 (Mar. 30, 2010) (hereafter, “HCERA”). In this 

report, references to PPACA include any amendments made by HCERA. The Department 

of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS), which 

is tasked with overseeing the establishment of exchanges, refers to exchanges as 

marketplaces.

For example, it is only through the 

exchanges that qualifying individuals seeking to purchase coverage can 

qualify for premium tax credits and cost-sharing reductions to lower the 

cost of their health plans and certain small businesses may qualify for tax 

credits to lower the cost of the coverage they purchase on behalf of their 

employees. PPACA also allows states and the federal government to take 

States may establish separate individual and small-business exchanges or a single 

exchange to serve both individuals and small employers—we refer to the latter as small 

businesses. Under PPACA, until 2016, states have the option to define “small businesses” 

either as those having from 1 through 100 full-time equivalent employees or those having 

from 1 through 50 full-time equivalent employees. Beginning in 2016, small businesses 

will be defined in all states as those with 100 or fewer full-time equivalent employees.

In this report, the term “state” includes the District of Columbia.

2

An issuer is an insurance company, insurance service, or insurance organization that is 

required to be licensed to engage in the business of insurance in a state.
Page 2 GAO-14-657 Issuer Participation in Health Insurance Exchanges

additional steps to encourage or require issuer participation in the 

exchanges.

Issuers seeking to participate in an individual or small-business exchange 

must first be approved to do so by the exchange in that state. In about 

one-third of states, the state chose to operate the exchange in 2014, 

known as a state-based exchange, and approved issuers for participation. 

In the remaining states that elected not to operate an exchange, the 

Department of Health and Human Services’ Centers for Medicare & 

Medicaid Services (CMS) was responsible for carrying out these 

responsibilities.3

Issuer participation is a key factor related to the extent to which an 

exchange will offer consumers a choice of plans. You asked us to 

examine the number and types of issuers participating in both the 

individual and small-business exchanges beginning in 2014, as well as 

how this compares with issuer participation in the individual and smallgroup markets prior to the exchanges.

These are known as federally facilitated exchanges.

4

1. the extent to which issuers that previously offered health plans in the 

individual and small-group health insurance markets participated in 

the 2014 exchanges, and

In this report we describe:

2. the issuers that participated in 2014 exchanges and the health plans 

they offered.

To answer these objectives, we identified and obtained data on issuers 

that participated in the 2014 exchanges and the plans that they offered in

each state’s rating areas.5

 3

In states not operating an exchange, PPACA requires the federal government to operate 

an exchange in that state. PPACA, § 1321(c), 124 Stat. at 186.

For those exchanges that were federally 

facilitated—34 individual and 32 small-business—we analyzed data that 

CMS collected from issuers as part of the agency’s certification of issuer 

4

The small-group market is the health insurance market under which individuals obtain 

health insurance coverage through a group health plan offered by a small employer.

5

Under PPACA, issuers are allowed to adjust premium rates within specified limits for 

plans based on the number of people covered under a particular policy, the covered 

individual’s age, smoking status, and area of residence. Each state can divide up areas of 

residence in the state into locations called rating areas.
 

Page 3 GAO-14-657 Issuer Participation in Health Insurance Exchanges

plans to be included in the 2014 exchanges.

6 This source also included 

data for a small number of state-based exchanges—2 individual and 1 

small-business—that chose to have CMS carry out certain functions on 

their behalf in 2014. To assess the data’s reliability, we interviewed CMS 

officials about the agency’s policies and procedures to ensure that the 

data captured all relevant issuers and that data submitted by issuers were 

accurate. In addition, we performed electronic tests of the data to identify 

any outliers or anomalies. We determined the data were sufficiently 

reliable for the purposes of our analysis. For the remaining 15 individual 

and 18 small-business exchanges that were state-based, complete data 

were not available from CMS and we obtained them directly from each 

state. To assess the reliability of the data obtained from states, we 

performed electronic tests of the data. When we found missing values or 

other anomalies, we followed up with state officials and incorporated the 

corrections we received. We determined the data were sufficiently reliable 

for the purposes of our analysis. We also identified federal requirements 

related to exchange participation by interviewing CMS officials and 

reviewing relevant laws and regulations. To obtain information about state 

participation requirements, we obtained information from each of the 

state-based exchanges.7

To identify the number of issuers previously offering health plans in the 

individual market and the small-group market, by state, we analyzed 

coverage data that PPACA required issuers to report to CMS.8

 

6

CMS Qualified Health Plan Landscape data, as of March 31, 2014, downloaded from 

Using the 

most recently available data, we identified issuers that participated in 

states’ 2012 individual and small-group markets and analyzed each 

issuer’s total number of covered life-years to determine their share of the 

https://www.healthcare.gov/health-and-dental-plan-datasets-for-researchers-and-issuers/

and last accessed on June 20, 2014.

7

According to CMS officials, there were no state requirements related to issuer 

participation in the federally facilitated exchanges.

8

PPACA requires issuers to report data on the percent of premiums spent on their 

enrollees’ medical claims, quality initiatives, and other costs, known as their medical loss 

ratio. Issuers must report these data to CMS every June and these data are based on the 

issuers’ experience for the prior calendar year. The 2012 data were the most recently 

available data at the time of our analysis. CMS Medical Loss Ratio Data, Public Use File 

for 2012, as of August 1, 2013, downloaded from 

http://www.cms.gov/CCIIO/Resources/Data-Resources/mlr.html and last accessed on 

June 23, 2014.
Page 4 GAO-14-657 Issuer Participation in Health Insurance Exchanges

individual and small-group market in that state.9 In addition, we 

categorized the issuers by size. We defined larger issuers as those with 

5 percent or more of the market in that state and smaller issuers as those 

with less than 5 percent of the market. We reviewed these data for 

reasonableness and consistency, including screening for outliers. We 

also reviewed documentation about the data and spoke with CMS officials 

about steps taken to ensure data reliability. Based on this review, we 

determined that the data used for our analysis were sufficiently reliable for 

our purposes. To describe the extent to which issuers participating in the 

2014 exchanges also participated in the applicable 2012 market, we 

matched 2014 issuers with those in the 2012 market using a unique code 

that CMS assigns to each issuer in each state. When we were not able to 

identify a match for a 2014 issuer code in the 2012 data, we used other 

information from CMS and the insurance company to determine whether 

the issuer participated in the 2012 market.

10

We conducted this performance audit from January 2014 to August 2014 

in accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

For each 2014 issuer that 

was participating in its respective market in 2012, we identified its share 

of that 2012 market. We did not determine whether multiple issuers in a 

state were affiliated with a parent company. For those 2014 issuers that 

participated in the 2012 markets, we also used the 2012 data to 

determine whether they were for-profit or not-for-profit entities, as this 

information was not available in CMS’s 2014 exchange data. For those 

2014 issuers that did not participate in the 2012 markets, we used 

documentation from the issuers and other sources to determine whether 

the issuers were for-profit or not-for-profit entities.

 9

Market share is the percentage of a total market, in terms of either value or volume, 

accounted for by the sales of a specific entity. In the health insurance industry, market 

share can be measured as the percentage of the total market held by an issuer in terms of 

beneficiary enrollment or health insurance premiums paid. One way to measure 

beneficiary enrollment is through covered life-years. Covered life-years represent the 

average number of lives insured, including dependents, on a pre-specified day over each 

of the 12 months in the reporting year.

10According to CMS officials, each insurance company will generally be assigned a single 

issuer code for each state in which it offers coverage. The officials indicated, however, 

that some insurance companies had differing issuer codes assigned within a single state 

in 2012 and 2014. The officials provided us with data to identify and match issuers with 

differing codes, and they indicated that this problem had been corrected for future years of 

data.
Page 5 GAO-14-657 Issuer Participation in Health Insurance Exchanges

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives.

PPACA contained several provisions with the potential to affect issuer 

participation in the individual and small-group health insurance markets 

starting in 2014. Specifically, it directed states to establish exchanges for 

individuals and small businesses by January 1, 2014. In states electing 

not to establish and operate either type of exchange, PPACA required the 

federal government to establish and operate the exchange. For 2014, 

about one-third of the states chose to operate their individual and smallbusiness exchanges, known as state-based exchanges. Specifically, in 

17 states, the state chose to operate both the individual exchange and 

the small-business exchange, known as the Small Business Health 

Options Program, or SHOP. In 32 states, the federal government 

operated both the individual and small-business exchanges, known as 

federally facilitated exchanges. In the remaining 2 states, the individual 

exchange was federally facilitated, while the small-business exchange 

was state-based. (See fig. 1.)

Background
Page 6 GAO-14-657 Issuer Participation in Health Insurance Exchanges

Figure 1: Health Insurance Exchange Arrangements for 2014
Page 7 GAO-14-657 Issuer Participation in Health Insurance Exchanges

All individual and small-business health plans, whether offered through an 

exchange or outside of an exchange, must comply with new insurance 

market reforms enacted under PPACA.11

To be certified to offer coverage through an exchange, issuers must meet 

additional requirements, including offering a minimum of one silver and 

one gold plan in any area in which it participates in an exchange. 

Catastrophic plans may be offered only in the individual exchanges, and 

not on the small-business exchanges, and may be offered only to certain 

individuals. Issuers can offer plans statewide or within different 

geographic regions, typically defined by rating areas. States could define 

their rating areas using counties, Metropolitan Statistical Areas,

These include, for example, a 

requirement to cover certain categories of benefits at standardized levels 

of coverage, which are categorized by “metal level” as catastrophic, 

bronze, silver, gold, or platinum, depending on the portion of health care 

costs expected to be paid by the health plan. They also include 

prohibitions on annual and lifetime limits on the dollar value of required 

benefits and on the denial of coverage or charging of higher premiums 

due to preexisting conditions. Some of these reforms were in effect in 

2012, while others did not take effect until 2014.

12

PPACA also requires that the federal government establish multi-state 

plans to be offered through each of the individual and small-business 

exchanges.

zip 

codes, or a combination of those options.

13

 11Certain of these reforms apply only to plans issued after March 23, 2010.

Specifically, multi-state plans are those that issuers offer 

under a contract with the U.S. Office of Personnel Management (OPM). 

PPACA requires the contracted issuers to offer at least two multi-state 

plans through each exchange and requires that at least one of the issuers 

with which OPM contracts be not-for-profit. Issuers of multi-state plans 

are allowed to phase in coverage, but must offer coverage in 60 percent 

of states in the first contract year and in all states by the third contract 

year. During the first two contract years, OPM indicated that it would not 

direct issuers to participate in particular states. For 2014, OPM entered 

12A Metropolitan Statistical Area consists of one or more counties that contain at least one 

core urban area with a population of 50,000 or more as well as adjacent counties that 

have a high degree of social and economic integration with the urban core, as measured 

by commuting ties.

13PPACA, §§ 1334,10104(q), 124 Stat. at 902.
Page 8 GAO-14-657 Issuer Participation in Health Insurance Exchanges

into a contract with the Blue Cross and Blue Shield Association to offer 

coverage in 31 states through the individual and small-business 

exchanges.

PPACA also established a program to foster the creation of consumergoverned, not-for-profit issuers of health coverage—referred to as 

Consumer Oriented and Operated Plans (CO-OP)—that would provide 

additional coverage options in the individual and small-business 

exchanges.14 As required by PPACA, CMS established a loan program 

through which qualified not-for-profit issuers could apply for federal 

funding to help cover startup costs associated with establishing a CO-OP 

and to help meet states’ solvency and reserve requirements for licensure. 

A CO-OP issuer may operate within specific areas of a state, statewide, 

or in multiple states.15 For 2014, 22 CO-OPs receiving federal loans 

offered coverage through the exchanges.16

The federal government and states instituted other provisions that relate 

to issuer participation in the exchanges. For example, for federally 

facilitated exchanges, CMS requires that issuers with more than 

20 percent market share in the small-group market participate in the 

small-business exchange as a condition of participation in the individual 

exchange.17 In adopting this requirement, CMS indicated that the purpose 

of this requirement is to promote robust participation in the small-business 

exchanges and expand plan choice.18

 14PPACA, § 1322, 124 Stat. at 187.

In addition, some states that 

operated their own exchanges enacted statutory, regulatory, or other

requirements governing issuer participation in exchanges. Seven states 

15Although a CO-OP may operate within specific areas of a state, PPACA requires CMS 

to prioritize loan applications from applicants that plan to operate on a statewide basis.

16CMS awarded loans to two additional organizations. One organization did not offer 

coverage in the exchange in 2014 and planned to offer coverage in 2015. The second 

organization was awarded loans, but it was unable to obtain licensure from the state and, 

as a result, CMS de-obligated a portion of the awarded loans.

1745 C.F.R. § 156.200(g). This rule also applies to issuers that are members of an issuer 

group that has at least one member with greater than 20 percent market share. For this 

requirement, CMS determines market share based on earned premium data (as opposed 

to covered life-years) contained in the most recently filed medical loss ratio report issuers 

must file under PPACA.

1878 Fed. Reg. 15410, 15502 (Mar. 11, 2013).
Page 9 GAO-14-657 Issuer Participation in Health Insurance Exchanges

reported requiring issuers participating in exchanges to offer a minimum 

number of health plans, while four states set maximum limits. Three 

states also reported requiring participation in individual and smallbusiness exchanges. For example, in Maryland, certain issuers that 

offered plans outside of the exchanges were also required to offer plans 

through the exchange. Further, four states reported establishing waiting 

periods related to exchange participation in future plan years for issuers 

that chose not to participate in the 2014 exchange. For example, 

Connecticut prohibited an issuer from re-entering the exchange for 

2 years if the issuer voluntarily ceased to participate in the exchange. 

(See table 1.)

Table 1: State-Based Exchanges with Requirements Related to Issuer Participation

Type of state participation requirements States that reported having requirements

Requires an issuer participating in the exchange to offer a minimum number 

of qualified health plans

California, Connecticut, District of Columbia, Maryland, 

Massachusetts, Minnesota, and New York

Limits the number of qualified health plans offered by an issuer participating 

in the exchange

Kentucky, Maryland, Nevada, and Oregon

Requires issuer participation in the exchange markets District of Columbia, Maryland, and Vermont

Imposes waiting periods restricting exchange participation in future plan 

years for issuers that choose not to participate in the 2014 exchange

Colorado, Connecticut, New York and Oregon

Source: State-based exchanges. | GAO-14-657

Note: In addition to these categories, states may have additional requirements that affect issuer 

participation. For example, Washington requires that catastrophic plans can only be sold on the 

exchange and may not be offered in the non-exchange individual market.

In most states, issuers with the largest share of the 2012 individual and 

small-group markets participated in the 2014 individual and smallbusiness exchanges. In 2012, a large number of issuers participated in 

state individual and small-group markets, although coverage was 

generally concentrated among a small number of these participating 

issuers. For example, while there was an average of 42 issuers in the 

2012 individual market, only 4 had at least a 5 percent share of the 

market and they accounted for a combined 87 percent of that market. 

(See fig. 2.) For 2014, in 40 states the issuer with the largest share of the 

2012 individual market participated in that state’s 2014 individual 

exchange. For the small-group market, this was the case in 41 states. In 

addition to participation from the largest issuer, most states had other 

issuers with at least 5 percent of the market participating in the 2014 

exchanges. For example, in 6 states all of the issuers with at least a 

5 percent share of the 2012 individual market also participated in the 

Most of the Largest 

Issuers in the 2012 

Individual and Smallgroup Markets 

Participated in the 

2014 Exchanges, with 

Exceptions in Some 

States
Page 10 GAO-14-657 Issuer Participation in Health Insurance Exchanges

2014 exchanges; this was the case for the small-business exchanges in 5 

states.

Figure 2: Issuer Participation in State Individual and Small-group Markets in 2012

However, in some states, issuers with the largest 2012 market share did 

not participate in the 2014 exchanges. Specifically, in the individual and 

small-group markets for 11 and 10 states, respectively, the largest issuer 

in 2012 did not participate in the 2014 exchanges. Among the 11 states 

for which that was the case for the individual market, there were 5 in 

which that issuer had the majority of the state’s 2012 market share;19 for 

the small-business exchange, this was the case in 3 of the 10 states.20

Most issuers with less than 5 percent of their 2012 market did not 

participate in the 2014 exchanges, although in many states more than 

 19In the other 6 states in which the issuer with the largest share of the 2012 individual 

market did not participate in the exchanges, those issuers held between 20 and 

40 percent of the state’s 2012 market.

20In the other 7 states in which the issuer with the largest share of the 2012 small-group 

market did not participate in the exchanges, those issuers held between 22 and 

39 percent of the state’s 2012 market. 
Page 11 GAO-14-657 Issuer Participation in Health Insurance Exchanges

one of these smaller issuers did participate. In 2012, states had an 

average of 36 and 15 issuers with less than a 5 percent share of the 

individual and small-group markets, respectively. Most of these smaller 

issuers did not participate in the 2014 exchanges. However, in most 

states, at least 1 of these smaller issuers did participate in the 2014 

individual exchanges; in 9 states, 5 or more smaller issuers participated. 

All smaller issuers that participated in the 2014 individual exchanges had 

an average market share of 0.6 percent in 2012.

In addition, some issuers that participated in the 2014 individual or smallbusiness exchanges had not participated in that respective 2012 market. 

For example, with regard to the individual market, there were 39 states in 

which at least 1 issuer that offered coverage through the exchange had 

not provided coverage in that respective 2012 market. The number of 

such issuers in each individual exchange ranged from 1 to 11, for a 

nationwide total of 99 (out of the 291 total issuers that participated in the 

individual exchanges). Of these, 23 were newly established through the 

federally funded CO-OP program.21 Some of the other issuers, however, 

had previously provided coverage in other markets. For example, in Iowa, 

we identified 3 issuers that were new to the 2014 individual market. While 

one of these was a newly established CO-OP, the other two had 

previously participated in the small-group market in that state. There were 

also several new issuers that had previously issued coverage in the 

Medicaid managed care market.22

In most states, for 2014 the issuers participating in the exchanges 

represented a mix of larger issuers, smaller issuers, and issuers new to 

that market. Overall, the issuers in each 2014 exchange that participated 

in the 2012 markets represented from 3 to 98 percent of that state’s 2012 

individual market and from 1 to 100 percent of that state’s 2012 smallgroup market, averaging about 56 percent in each market. An average of 

For example, one insurance company 

that issued coverage in multiple Medicaid managed care markets in 2012 

was a new entrant to the individual markets through 6 state exchanges.

 21Although there are 22 CO-OPs, 1 CO-OP offers coverage in two states, which are 

counted uniquely in the data. Therefore, 23 issuers are counted.

22The Medicaid program is a joint federal-state program that finances health insurance 

coverage for certain categories of low-income individuals. Nearly all states enroll some 

Medicaid beneficiaries in a form of managed care. Under Medicaid managed care, states 

contract with health plans and prospectively pay the plans a fixed monthly rate per 

enrollee to provide or arrange for health services.
Page 12 GAO-14-657 Issuer Participation in Health Insurance Exchanges

4 larger issuers in the individual market and 3 issuers in the small-group 

market accounted for the majority of these market-share totals in each 

state and, on average, more smaller issuers—those that had less than 

5 percent of the 2012 market—than larger issuers participated in the 

individual exchanges in 2014. (See fig.3 for the number of participating 

issuers, by category of 2012 market share. Also, see app. I for state-bystate information on issuer participation in the exchanges and their 2012 

market share.)
Page 13 GAO-14-657 Issuer Participation in Health Insurance Exchanges

Figure 3: Issuers Participating in the 2014 Exchanges across All States, by Category of Market Share in 2012
Page 14 GAO-14-657 Issuer Participation in Health Insurance Exchanges

In nearly all states, multiple issuers participated in the individual and 

small-business exchanges in 2014; an average of 6 issuers and 4 

issuers, respectively. Overall, the number of participating issuers varied 

widely between states; from 1 to 17 issuers through the individual 

exchange and from 1 to 13 issuers through the small-business 

exchanges. However, almost all exchanges had more than 1 issuer 

participating—49 individual exchanges and 45 small-business exchanges. 

Further, in 31 states, both the individual and small-business exchanges 

had 3 or more participating issuers.23 (See fig. 4 and app. II.)

 23In general, states that had a higher number of issuers participating in the 2014 

exchanges also had a higher number of issuers participating in the 2012 markets.

Nearly All 2014 

Exchanges Had 

Multiple Participating 

Issuers, Which 

Generally Offered 

More Plans than the 

Minimum Required by 

PPACA
Page 15 GAO-14-657 Issuer Participation in Health Insurance Exchanges

Figure 4: Number of Issuers Participating in the 2014 Individual and Small-business Exchanges, by State

Interactivity instructions: Roll over on one of the two tabs to see data for each category. See appendix II for the non-interactive, printer-friendly version. 

Sources: Centers for Medicare & Medicaid Services and state-based exchanges (data); Map Resources (map). | GAO-14-657

Individual exchanges Small-business exchanges

FL

LA

MS GA AL

SC AR

TX

NC

TN

NM

AZ OK

KY

VA

MD

DE

KS MO

CO WV

NJ

IN

OH

NV

UT

CA

RI

CT

PA

IL

MA

NE

IA

WY

NY

VT

NH

MI

SD

OR

WI

ND ME

ID

MT

WA

MN

Hawaii

AK

DC

1 issuer

2-3 issuers

4-6 issuers

7-17 issuers
Page 16 GAO-14-657 Issuer Participation in Health Insurance Exchanges

More than half of participating issuers offered coverage through both the 

individual and small-business exchanges, although more issuers 

participated in the individual exchanges than in the small-business 

exchanges. Of the 323 issuers that participated in the exchanges, 175

participated in both the individual and small-business exchanges in their 

state. Of the remaining 148 issuers, 116 participated in the individual 

exchange only and 32 participated in the small-business exchange only. 

In 30 states, there were more issuers participating in the individual 

exchange than the small-business exchange.24

Most issuers offering coverage through the 2014 exchanges were forprofit entities, although the portion that was not-for-profit was greater than 

in the 2012 markets. In 2014, about 40 percent of issuers participating in 

the exchanges were not-for-profit with the remaining 60 percent for-profit. 

In comparison, in 2012, 9 percent of all issuers were not-for-profit and 

91 percent were for-profit. In part, the difference in the percentage of notfor-profit issuers between the 2012 individual market and the 2014 

individual exchanges could be because issuers with the largest share of 

the 2012 market were more likely to be not-for-profit and more likely to 

participate in the exchanges.25 In addition, both the multi-state plan and 

CO-OP programs established under PPACA require inclusion of not-forprofit issuers.26

Issuers varied substantially in the number of plans they offered in each 

rating area through the 2014 exchanges. In the individual exchanges, 

each issuer offered an average of 10 plans in each rating area. Of the 

291 issuers, 257 offered more than the minimum number of plans 

For example, of the 116 not-for-profit issuers offering 

coverage through the exchanges, 20 percent were the 22 newly created 

CO-OPs. In 9 individual and 9 small-business exchanges, a CO-OP 

represented the only not-for-profit issuer on the exchange.

 24In 2012, the small-group market generally had less than half as many participating 

issuers as the individual market, with less than one third of all issuers participating in both 

markets.

25Among those issuers with the largest market share in 2012, 57 percent were not-forprofit. In comparison, 7 percent of those issuers with less than 5 percent market share in 

2012 were not-for-profit. Additional issuers may have offered coverage outside of the 2014 

exchanges.

26PPACA requires that all CO-OP issuers be not-for-profit and that at least one contracted 

multi-state plan program issuer in each state be not-for-profit. Of the 36 issuers offering 

multi-state plans in 31 states in 2014, 14 were not-for-profit, and 22 were for-profit.
Page 17 GAO-14-657 Issuer Participation in Health Insurance Exchanges

required by PPACA—one gold and one silver plan—in all the rating areas 

in which they offered coverage. Of the 207 issuers in the small-business 

exchanges, each issuer offered an average of 12 plans in each rating 

area and 183 offered more than the minimum number of plans required in 

all the rating areas they offered coverage in. (See table 2 for the range of 

plans offered. Also see app. III for a state-by-state listing of the number of

rating areas and number of plans offered through the exchanges.)

Table 2: Number of Plans Offered by Issuers Participating in the 2014 Exchanges 

across Rating Areas

Number of plans offered in each rating area in 2014

Type of exchange Minimum Average Maximum

Individual 2 10 72

Small-business 2 12 129

Sources: Centers for Medicare & Medicaid Services and state-based exchanges. | GAO-14-657

Similarly, the total number of plans available to consumers in a given 

rating area through the exchanges varied greatly. For example, in the 

individual exchanges, the total number of plans available in a given rating 

area ranged from 7 to 178, averaging about 41 plans. (See fig. 5 and 

app. IV.) In all rating areas, consumers could select from at least one 

bronze, one silver, and two gold level plans and about 58 percent of 

rating areas had plans available at all five metal levels. However, in the 

remaining 42 percent of rating areas, consumers did not have access to a 

platinum plan. The trends for the small-business exchanges were similar, 

and all rating areas had at least one silver and one gold plan available.27

While these represent the number of plans available to consumers 

through the exchanges, the total number of plans available to a consumer 

in each market would include the additional plans that were available 

outside the exchanges.28

 27Catastrophic plans are offered only in the individual exchanges; therefore, there are only 

four metal levels of coverage offered in the small-business exchanges.

These plans were required to meet many of the 

same requirements as the exchange plans, but individuals enrolling in 

plans outside the exchanges were not eligible for premium tax credits and 

28Consistent national data on issuers and plans available outside of the exchanges were 

not available at the time we prepared this report.
Page 18 GAO-14-657 Issuer Participation in Health Insurance Exchanges

cost-sharing reductions to make the coverage more affordable.29 Small 

businesses enrolling in coverage outside of the exchanges were similarly 

ineligible for tax credits.

 29Individuals purchasing coverage through the exchanges may be eligible for incomebased tax credits to reduce the premiums they pay, and may also be eligible for 

subsidized plans that lower their out-of-pocket costs, such as deductibles and 

copayments.
Page 19 GAO-14-657 Issuer Participation in Health Insurance Exchanges

Figure 5: Number of Plans Offered by Issuers in the 2014 Individual and Small-business Exchanges, by State

Interactivity instructions: Roll over on one of the two tabs to see data for each category. See appendix IV for the non-interactive, printer-friendly version. 

Sources: Centers for Medicare & Medicaid Services and state-based exchanges (data); Map Resources (map). | GAO-14-657

Individual exchanges Small-business exchanges

FL

LA

MS GA AL

SC AR

TX

NC

TN

NM

AZ OK

KY

VA

MD

DE

KS MO

CO WV

NJ

IN

OH

NV

UT

CA

RI

CT

PA

IL

MA

NE

IA

WY

NY

VT

NH

MI

SD

OR

WI

ND ME

ID

MT

WA

MN

Hawaii

AK

DC

11-25 plans

26-50 plans

51-100 plans

101-280 plans
Page 20 GAO-14-657 Issuer Participation in Health Insurance Exchanges

Some of this variability in plan availability may be related to the population 

of the state, although we did not find consistent differences between 

states when we examined other factors. One factor that could influence 

an issuer’s decision to participate in a market is the number of potential 

consumers.30 We found, overall, that more populous states tended to 

have more plans available than less populous states. For both the 

individual and small-business exchanges, collectively, issuers in the 25 

most populous states tended to offer a higher than average number of 

plans, while those in less populous states were less likely to do so.31 (See 

fig. 6 and fig. 7) However, other factors we examined did not appear to 

influence issuers’ decisions to participate in exchanges. A key difference 

between exchanges was that about one-third of states chose to operate 

their exchanges, and these states had the ability to impose limitations on 

exchange participation and plan offerings. Based on our review, the statebased exchanges did not appear to have either a greater or lesser 

number of available plans. For example, among the 10 states with the 

highest average number of plans, 3 states had state-based exchanges 

and 7 had federally facilitated exchanges.32 Similarly, among the 10 

states with the lowest average number of plans, 3 states had state-based 

exchanges and 7 had federally facilitated exchanges.33

 30The pooling of risk is fundamental to insurance. For example, a large pool of consumers 

of similar risks exhibit stable and measurable characteristics that enable health insurance 

companies to estimate future costs with an acceptable degree of accuracy. This, in turn, 

enables actuaries to determine premium levels that will be stable over time, relative to 

overall trends.

In addition, of the 

7 state-based exchanges that set requirements for a minimum number of 

plans that issuers must offer in each metal level, only the New York 

exchange had higher than the average number of plans per rating area in 

both the individual and small-business exchanges, while Maryland, 

Massachusetts, Minnesota and the District of Columbia had higher than 

31Although we did not have information on the number of plans available in 2012, we 

found that states with a larger number of 2012 issuers also tended to have a larger 

number of issuers participate in the 2014 exchanges.

32Among the 10 states with the highest average number of plans, Colorado, Oregon, and 

Utah had state-based exchanges, while Arizona, Florida, Ohio, Oklahoma, Pennsylvania, 

Tennessee, and Wisconsin had federally facilitated exchanges.

33Among the 10 states with the lowest average number of plans, Connecticut, Rhode 

Island, and Vermont had state-based exchanges, while Alabama, Delaware, Missouri, 

New Hampshire, North Carolina, West Virginia, and Wyoming had federally facilitated 

exchanges.
Page 21 GAO-14-657 Issuer Participation in Health Insurance Exchanges

the average number of plans per rating area in the small-group market.34

Figure 6: Number of Plans Available in Each 2014 Individual Exchange, by State 

Population Category

We did not assess other factors that could lead to the variability in plan 

availability.

 34California, Massachusetts, and New York required participating issuers to offer between 

five and seven plans in any rating area in which they participate. In comparison, three 

other states, Connecticut, the District of Columbia, and Maryland—each required a 

minimum of three plans. While Minnesota did not require issuers to offer a certain 

minimum number of plans, the state did require issuers to offer health plans at the same 

metal level and rating areas that the issuer currently offered in the non-exchange 

individual and small-group markets.
Page 22 GAO-14-657 Issuer Participation in Health Insurance Exchanges

Figure 7: Number of Plans Available in Each 2014 Small-business Exchange, by 

State Population Category

Plans offered under the two new federal programs—the multi-state plan 

program and CO-OP program—were generally among several plans 

offered in a rating area and, in those rating areas, tended to comprise a 

more significant portion of the plans offered in the small-business 

exchanges. Issuers offered multi-state plans, under contract with OPM, in 

about half of the rating areas in the 2014 individual exchanges, but in only 

about 2 percent of the small-business exchanges.35

 35Issuers of multi-state plans are allowed to phase in coverage by state, but must offer 

coverage in 60 percent of states in the first contract year and in all states by the third 

contract state. In the final rule implementing the multi-state plan program, OPM 

encouraged issuers to expand coverage to all rating areas within a state, but did not 

require it; OPM has indicated it will continue to assess issuers’ capacity to expand 

statewide through its annual contract negotiations.

Within these rating 

areas, the multi-state plans constituted an average of 10 percent (1 to 

67 percent) of the individual exchange plans and 18 percent (1 to 
 

Page 23 GAO-14-657 Issuer Participation in Health Insurance Exchanges

50 percent) of the small-business exchange plans. Similarly, CO-OP 

plans were offered in about one-third of the rating areas. Within these, the 

CO-OP plans constituted an average of 23 percent (3 to 87 percent) of 

the individual exchange plans and 39 percent (7 to 100 percent) of the 

small-business exchange plans.

We received technical comments on a draft of this report from the 

Department of Health and Human Services and incorporated them as 

appropriate.

As agreed with your offices, unless you publicly announce the contents of 

this report earlier, we plan no further distribution until 30 days from the 

report date. At that time, we will send copies to the Secretary of Health 

and Human Services. In addition, the report will be available at no charge 

on the GAO website at http://www.gao.gov.

If you or your staff have any questions about this report, please contact 

me at (202) 512-7114 or dickenj@gao.gov. Contact points for our Offices 

of Congressional Relations and Public Affairs may be found on the last 

page of this report. GAO staff who made key contributions to this report 

are listed in Appendix V.

John E. Dicken

Director, Health Care

Agency Comments
Appendix I: Issuers’ Participation in the 2014 

Exchanges and Their 2012 Market Share

Page 24 GAO-14-657 Issuer Participation in Health Insurance Exchanges

In this appendix, we present the 2012 market share of issuers that 

participated in the 2014 individual and small-business exchanges. Table 3 

provides this information for those issuers in the 2014 individual 

exchanges; table 4 provides this information for those issuers in the 2014 

small-business exchanges.

Table 3: 2012 Market Share of Issuers Participating in the 2014 Individual Exchanges, by State

Count of issuers participating in the 2014 exchanges

2012 market share of issuers 

participating in the 2014 

exchanges

State Total

5 percent or more 

share of 2012 market

Less than 5 percent 

share of 2012 market

Did not participate 

in 2012 market

Highest

(Percent)

Total for all issuers

(Percent)

Alabama 2 1 1 0 91* 92

Alaska 2 2 0 0 60* 65

Arizona 10 3 2 5 50* 60

Arkansas 3 2 1 0 79* 85

California 12 2 7 3 17 30

Colorado 10 1 5 4 9 12

Connecticut 3 1 0 2 45* 45

Delaware 3 2 0 1 49* 57

District of Columbia 4 4 0 0 51* 90

Florida 11 1 6 4 48* 52

Georgia 5 2 2 1 18 34

Hawaii 2 2 0 0 52* 98

Idaho 4 2 1 1 45* 62

Illinois 8 2 5 1 67* 83

Indiana 4 1 1 2 61* 63

Iowa 4 0 1 3 3 3

Kansas 4 3 1 0 42* 78

Kentucky 3 2 0 1 80* 96

Louisiana 5 3 1 1 64* 83

Maine 2 1 0 1 49* 49

Maryland 6 3 1 2 39* 69

Massachusetts 11 5 3 3 39* 95

Michigan 12 1 6 5 52* 59

Minnesota 5 1 2 2 59* 63

Mississippi 2 1 0 1 10 10

Missouri 4 3 0 1 33* 61

Montana 3 2 0 1 62* 67

Appendix I: Issuers’ Participation in the 2014 

Exchanges and Their 2012 Market Share
Appendix I: Issuers’ Participation in the 2014 

Exchanges and Their 2012 Market Share

Page 25 GAO-14-657 Issuer Participation in Health Insurance Exchanges

Count of issuers participating in the 2014 exchanges

2012 market share of issuers 

participating in the 2014 

exchanges

State Total

5 percent or more 

share of 2012 market

Less than 5 percent 

share of 2012 market

Did not participate 

in 2012 market

Highest

(Percent)

Total for all issuers

(Percent)

Nebraska 4 1 1 2 69* 70

Nevada 4 1 1 2 7 7

New Hampshire 1 0 0 1 0 0

New Jersey 4 1 2 1 64* 70

New Mexico 4 1 0 3 49* 49

New York 17 2 4 11 15* 36

North Carolina 2 1 1 0 85* 89

North Dakota 3 1 1 1 75* 76

Ohio 12 1 7 4 36* 41

Oklahoma 6 1 3 2 63* 70

Oregon 11 5 1 5 17 58

Pennsylvania 14 5 9 0 33* 74

Rhode Island 2 1 0 1 94* 94

South Carolina 4 2 1 1 51* 59

South Dakota 3 2 1 0 8 17

Tennessee 4 2 1 1 39* 45

Texas 12 3 4 5 58* 76

Utah 6 2 0 4 41* 47

Vermont 2 1 1 0 90* 90

Virginia 8 1 5 2 7 13

Washington 8 2 2 4 39* 48

West Virginia 1 1 0 0 61* 61

Wisconsin 13 2 7 4 12 36

Wyoming 2 1 1 0 38* 40

Sources: Centers for Medicare & Medicaid Services and state-based exchanges. | GAO-14-657

Notes: We did not determine whether multiple issuers in a state were affiliated with a parent 

company; therefore, a particular issuer in the individual exchange may be new to that market in 2014 

even though other issuers that were part of the same parent company may have participated in the 

2012 individual market. 

*Represents the issuer with the highest market share in that state in 2012.
Appendix I: Issuers’ Participation in the 2014 

Exchanges and Their 2012 Market Share

Page 26 GAO-14-657 Issuer Participation in Health Insurance Exchanges

Table 4: 2012 Market Share of Issuers Participating in the 2014 Small-business Exchanges, by State

Count of issuers participating in the 2014 exchanges

2012 market share of issuers 

participating in the 2014 

exchanges

State Total

5 percent or more 

share of 2012 market

Less than 5 percent 

share of 2012 market

Did not participate 

in 2012 market

Highest

(Percent)

Total for all 

issuers (Percent)

Alabama 2 1 0 1 97* 97

Alaska 2 2 0 0 69* 75

Arizona 5 2 1 2 25* 45

Arkansas 1 1 0 0 48* 48

California 6 2 4 0 31* 41

Colorado 7 2 4 1 25 37

Connecticut 3 1 1 1 37* 37

Delaware 2 2 0 0 65* 88

District of Columbia 7 3 4 0 50* 98

Florida 5 1 3 1 28* 31

Georgia 3 1 2 0 25* 30

Hawaii 2 2 0 0 45* 67

Idaho 3 2 1 0 50* 64

Illinois 3 1 1 1 59* 63

Indiana 2 2 0 0 55* 61

Iowa 5 0 4 1 1 2

Kansas 2 2 0 0 59* 66

Kentucky 4 1 2 1 70* 78

Louisiana 4 2 1 1 64* 82

Maine 2 1 0 1 48* 48

Maryland 13 3 9 1 57* 100

Massachusetts 11 4 4 3 39* 96

Michigan 10 3 5 2 42* 82

Minnesota 3 2 1 0 35* 63

Mississippi 1 0 0 1 0 0

Missouri 2 2 0 0 39* 48

Montana 3 2 0 1 69* 79

Nebraska 4 2 0 2 56* 71

Nevada 2 0 1 1 1 1

New Hampshire 1 1 0 0 68* 68

New Jersey 4 2 1 1 23 32

New Mexico 5 4 0 1 29* 76
Appendix I: Issuers’ Participation in the 2014 

Exchanges and Their 2012 Market Share

Page 27 GAO-14-657 Issuer Participation in Health Insurance Exchanges

Count of issuers participating in the 2014 exchanges

2012 market share of issuers 

participating in the 2014 

exchanges

State Total

5 percent or more 

share of 2012 market

Less than 5 percent 

share of 2012 market

Did not participate 

in 2012 market

Highest

(Percent)

Total for all 

issuers (Percent)

New York 9 3 2 4 29 54

North Carolina 1 1 0 0 62* 62

North Dakota 3 1 2 0 86* 87

Ohio 6 1 4 1 39* 47

Oklahoma 4 2 2 0 55* 65

Oregon 8 3 1 4 22* 53

Pennsylvania 11 5 6 0 23* 71

Rhode Island 3 1 1 1 75* 77

South Carolina 3 2 0 1 59* 71

South Dakota 3 2 1 0 22 34

Tennessee 2 1 0 1 68* 68

Texas 2 1 1 0 46* 47

Utah 3 1 1 1 41* 41

Vermont 2 1 1 0 34 35

Virginia 5 4 1 0 16 46

Washington 1 0 1 0 5 5

West Virginia 1 1 0 0 63* 63

Wisconsin 9 0 8 1 3 13

Wyoming 2 2 0 0 56* 62

Sources: Centers for Medicare & Medicaid Services and state-based exchanges. | GAO-14-657

Notes: We did not determine whether multiple issuers in a state were affiliated with a parent 

company; therefore, a particular issuer in the small-business exchange may be new to that market in 

2014 even though other issuers that were part of the same parent company may have participated in 

the 2012 small-group market.

*Represents the issuer with the highest market share in that state in 2012.
Appendix II: Number of Issuers Participating in 

the 2014 Individual and Small-business 

Exchanges, by State

Page 28 GAO-14-657 Issuer Participation in Health Insurance Exchanges

Table 5 presents information from interactive figure 4 on the number of 

issuers participating in the individual and small business exchanges in 

2014, by state.

Table 5: Number of Issuers Participating in the 2014 Exchanges, by State

Number of issuers participating in the 2014 Exchanges

State Individual Exchange Small-business Exchange

Alabama 2 2

Alaska 2 2

Arizona 10 5

Arkansas 3 1

California 12 6

Colorado 10 7

Connecticut 3 3

Delaware 3 2

District of Columbia 4 7

Florida 11 5

Georgia 5 3

Hawaii 2 2

Idaho 4 3

Illinois 8 3

Indiana 4 2

Iowa 4 5

Kansas 4 2

Kentucky 3 4

Louisiana 5 4

Maine 2 2

Maryland 6 13

Massachusetts 11 11

Michigan 12 10

Minnesota 5 3

Mississippi 2 1

Missouri 4 2

Montana 3 3

Nebraska 4 4

Nevada 4 2

New Hampshire 1 1

New Jersey 4 4

Appendix II: Number of Issuers Participating 

in the 2014 Individual and Small-business 

Exchanges, by State
Appendix II: Number of Issuers Participating in 

the 2014 Individual and Small-business 

Exchanges, by State

Page 29 GAO-14-657 Issuer Participation in Health Insurance Exchanges

Number of issuers participating in the 2014 Exchanges

State Individual Exchange Small-business Exchange

New Mexico 4 5

New York 17 9

North Carolina 2 1

North Dakota 3 3

Ohio 12 6

Oklahoma 6 4

Oregon 11 8

Pennsylvania 14 11

Rhode Island 2 3

South Carolina 4 3

South Dakota 3 3

Tennessee 4 2

Texas 12 2

Utah 6 3

Vermont 2 2

Virginia 8 5

Washington 8 1

West Virginia 1 1

Wisconsin 13 9

Wyoming 2 2

Sources: Centers for Medicare & Medicaid Services and state-based exchanges. | GAO-14-657
Appendix III: Number of Plans Offered by 

Issuers Participating in the 2014 Exchanges 

across Rating Areas

Page 30 GAO-14-657 Issuer Participation in Health Insurance Exchanges

Table 6 presents information on the number of plans issuers offered in 

each state in the individual and small-business exchanges across rating 

areas in 2014.

Table 6: Number of Plans Offered by Issuers Participating in the 2014 Exchanges across Rating Areas

Number of plans offered per rating area

Individual exchange Small-business exchange

State

Number of rating 

areas in state Average Minimum Maximum Average Minimum Maximum

Alabama 13 8 7 12 17 17 17

Alaska 3 36 36 36 24 24 24

Arizona 7 99 79 124 73 56 104

Arkansas 7 25 11 41 3 3 3

California 19 29 19 45 16 8 23

Colorado 11 110 90 149 79 56 90

Connecticut 8 19 19 19 12 12 12

Delaware 1 21 21 21 11 11 11

District of Columbia 1 34 34 34 267 267 267

Florida 67 68 27 169 6 2 40

Georgia 16 31 15 68 8 3 16

Hawaii 1 36 36 36 27 27 27

Idaho 7 37 17 49 36 18 44

Illinois 13 49 35 71 31 18 39

Indiana 17 31 16 63 81 5 134

Iowa 7 44 35 63 35 21 63

Kansas 7 41 36 47 5 5 7

Kentucky 8 26 18 38 17 12 24

Louisiana 8 39 28 58 30 26 33

Maine 4 22 19 31 9 8 11

Maryland 4 37 36 40 100 95 104

Massachusetts 3 37 8 67 36 7 65

Michigan 16 46 25 62 46 19 68

Minnesota 9 37 14 77 43 19 63

Mississippi 6 23 18 24 11 11 11

Missouri 10 19 12 25 3 2 3

Montana 4 29 29 29 22 22 22

Nebraska 4 37 25 57 31 23 43

Nevada 4 34 15 50 12 3 19

Appendix III: Number of Plans Offered by 

Issuers Participating in the 2014 Exchanges 

across Rating Areas
Appendix III: Number of Plans Offered by 

Issuers Participating in the 2014 Exchanges 

across Rating Areas

Page 31 GAO-14-657 Issuer Participation in Health Insurance Exchanges

Number of plans offered per rating area

Individual exchange Small-business exchange

State

Number of rating 

areas in state Average Minimum Maximum Average Minimum Maximum

New Hampshire 1 11 11 11 3 3 3

New Jersey 1 36 36 36 29 29 30

New Mexico 5 39 38 45 51 49 57

New York 8 131 91 174 156 96 192

North Carolina 16 21 14 31 9 9 9

North Dakota 4 33 33 33 22 20 23

Ohio 17 54 32 122 28 9 73

Oklahoma 5 52 29 70 46 24 65

Oregon 7 72 63 96 57 51 67

Pennsylvania 9 56 27 103 42 17 65

Rhode Island 1 12 12 12 16 16 16

South Carolina 46 29 27 32 12 12 12

South Dakota 4 35 35 35 16 16 16

Tennessee 8 52 30 74 7 2 10

Texas 26 37 18 99 18 16 21

Utah 6 74 59 91 52 32 70

Vermont 1 20 20 20 18 18 18

Virginia 12 43 24 69 20 3 39

Washington 5 38 34 46 5 5 5

West Virginia 11 13 13 13 4 4 4

Wisconsin 16 86 16 175 52 14 103

Wyoming 3 18 18 18 16 16 16

Sources: Centers for Medicare & Medicaid Services and state-based exchanges. | GAO-14-657
Appendix IV: Number of Plans Offered by 

Issuers in 2014 Individual and Small-business 

Exchanges

Page 32 GAO-14-657 Issuer Participation in Health Insurance Exchanges

Table 7 presents information from interactive figure 5 on the number of 

plans issuers offered in each state for the individual and small-business 

exchanges in 2014.

Table 7: Number of Plans Offered by Issuers in the 2014 Exchanges, by State

Number of Plans Offered 

in the 2014 Exchanges

State Individual Exchange Small-business Exchange

Alabama 17 17

Alaska 36 24

Arizona 199 104

Arkansas 71 3

California 90 40

Colorado 149 90

Connecticut 19 12

Delaware 21 11

District of Columbia 34 267

Florida 247 63

Georgia 74 16

Hawaii 36 27

Idaho 61 55

Illinois 122 45

Indiana 114 134

Iowa 88 75

Kansas 65 7

Kentucky 38 24

Louisiana 77 45

Maine 31 11

Maryland 44 104

Massachusetts 111 107

Michigan 73 68

Minnesota 78 63

Mississippi 34 11

Missouri 48 5

Montana 29 22

Nebraska 57 43

Nevada 61 19

New Hampshire 11 3

Appendix IV: Number of Plans Offered by 

Issuers in 2014 Individual and Smallbusiness Exchanges
Appendix IV: Number of Plans Offered by 

Issuers in 2014 Individual and Small-business 

Exchanges

Page 33 GAO-14-657 Issuer Participation in Health Insurance Exchanges

Number of Plans Offered 

in the 2014 Exchanges

State Individual Exchange Small-business Exchange

New Jersey 36 30

New Mexico 45 57

New York 280 320

North Carolina 65 11

North Dakota 33 23

Ohio 210 196

Oklahoma 75 65

Oregon 102 74

Pennsylvania 161 112

Rhode Island 12 16

South Carolina 52 12

South Dakota 35 16

Tennessee 84 10

Texas 129 21

Utah 96 70

Vermont 20 18

Virginia 106 39

Washington 46 5

West Virginia 13 4

Wisconsin 257 197

Wyoming 18 16

Sources: Centers for Medicare & Medicaid Services and state-based exchanges. | GAO-14-657
Appendix V: GAO Contact and Staff 

Acknowledgments

Page 34 GAO-14-657 Issuer Participation in Health Insurance Exchanges

John E. Dicken, (202)512-7114 or dickenj@gao.gov. 

In addition to the contact named above, William Hadley 

(Assistant Director), Sandra George, Laurie Pachter, Ann Tynan, 

and Stephen Ulrich made key contributions to this report.

Appendix V: GAO Contact and Staff 

Acknowledgments

GAO Contact

Staff 

Acknowledgments

(291173)
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