165 Counties Face ACA Insurer Exit 2026 — Only One Left
165 U.S. counties now have only one ACA insurer in 2026, up from 93 counties last year, so a one-carrier market is becoming a real loss of choice for people who need coverage.
The number that matters
9 average ACA issuers per state in 2026, down from 9.6 in 2025; this is the average number of insurers offering plans on the marketplaces.
How it quietly costs you
The first quiet cost is market exit reducing competition, which lets remaining insurers set higher premiums and narrows plan choice for people shopping on the ACA exchanges. KFF found that three in 10 U.S. counties have fewer ACA insurers in 2026, and 165 counties have only one insurer, compared with 93 counties last year.
The cost of inaction is concrete: when enhanced premium tax credits expired at the end of 2025, ACA sign-ups fell by over 1 million from the 2025 to 2026 open-enrollment periods, and KFF says further membership declines are expected as 2026 progresses.
Old vs better: the marketplace averaged 9.6 issuers per state in 2025 versus 9 in 2026, so the “better” benchmark is the prior year’s broader insurer participation.
The second, compounding trap
The second layer is subsidy erosion plus premium growth, which increases the net monthly bill even for people who stay insured. KFF reports that the expiration of enhanced premium tax credits drove enrollment down, while insurers’ 2027 rate filings show a median premium increase of 14% for ACA plans in the first wave of submissions analyzed by KFF.
The long-run cost is that a person who remains in the market can face a double hit: fewer insurers to choose from now, and materially higher sticker prices later if the 2027 filing pattern holds.
What this looks like in practice
Maya, 42, is a self-employed graphic designer in Ohio earning $58,000 a year, enrolled in an ACA silver plan with a household premium tax credit and a current marketplace premium of about $420 a month before subsidy. She is 23 years from retirement and lives in a county that went from two carriers to one.
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Discovery 1: Maya learns her county is now a one-insurer county, which means her bargaining power is gone and her choice set is worse than in 93 counties last year that were one-carrier counties; that shift is part of the broader three-in-10 counties with fewer ACA insurers in 2026.
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Discovery 2: She learns the market is shrinking nationally: the average issuers per state fell from 9.6 to 9, which is a measurable deterioration in competition rather than a local anomaly.
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Discovery 3: She learns that if she waits and 2027 filings reflect current submissions, her premium can rise by a median 14%, which would push a $420 monthly premium to about $479 before any subsidy change.
The full cost of doing nothing
For Maya, the combined effect of one fewer insurer and premium inflation can plausibly add about $708 per year to her before-subsidy premium if a 14% increase applies to her $420/month plan, or about $5.9K over seven years, before accounting for subsidy changes or switching costs. This is a simple illustrative model using KFF’s median 2027 rate increase and her current monthly premium; it does not assume changes in income, subsidy eligibility, or plan metal level.
What to do about it
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Check your county’s insurer count in HealthCare.gov’s plan shopping flow and compare it with last year’s options.
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Use the HealthCare.gov Marketplace plan search and county-level plan display.
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Enter your ZIP code and household details.
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Note how many insurers and plans appear for your county and compare premium totals.
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Good looks like at least 2+ insurers in your county; 1 insurer means very limited competition.
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Verify your subsidy estimate with the official Marketplace calculator before the next enrollment window.
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Use the HealthCare.gov premium tax credit and cost-sharing help tools.
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Input household income, tax-filing status, and household size.
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Compare the displayed net premium to your current payment and estimate your out-of-pocket cost under a higher-rate scenario.
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Good looks like keeping your net premium stable even if the gross premium rises.
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Compare your current plan against at least one alternate metal tier in your county.
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Use the Marketplace plan compare tool on HealthCare.gov.
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Pull your current plan, one silver plan, and one bronze plan.
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Compare monthly premium, deductible, and out-of-pocket maximum.
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Good looks like a lower net premium without a large jump in deductible or out-of-pocket maximum.
A myth worth clearing up
Myth: “If my insurer leaves, I’ll automatically be protected and can ignore open enrollment.” Fact: Carrier exits reduce options immediately, and KFF shows six carriers had already announced exits for 2027 as of June 22, 2026, so consumers need to actively re-shop rather than assume continuity.
Sources
Researched 2026-07-17.
Corrections & disclosure: an AI-assisted, human-reviewed guide. Every figure is dated and sourced above. Spot something out of date or wrong? Tell us and we’ll correct it — corrections are noted here and in the video description.
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