MARKET VIEWCount of carriers at the state level

While new entrants continue to emerge, there are fewer exchange carriers in 2017 than in any prior year

2017 exchange market: Carrier participation trends

McKinsey Center for U.S. Health System Reform

CONSUMER VIEWPercentage of QHP-eligible consumers2

MARKET VIEWCount of carriers at a county level

METHODOLOGYThe above findings are based on publicly available information. Carrier participation is based on final exchange offering information from healthcare.gov and all state-based exchanges.

To calculate the counts of carrier participation, we analyzed the number of unique carrier names. that are offering plans on-exchange. In the case where a single parent company offers plans under multiple carrier names, we count each carrier separately. To calculate the consumer view of carrier participation, we analyzed the number of unique parent companies that are offering plans on-exchange, to be reflective of what a consumer perceives.

Carrier's participation status in a given year and state is defined as follows:

Incumbent: A carrier that offered exchange plans during the prior year. For 2014 only, these are carriers that had individual market experience in 2013 in that given state.

Withdrawal: A carrier that stopped participating on-exchange. For 2013 to 2014 withdrawals, these are carriers with individual experience in a given state that did not enter exchanges in 2014.

New entrant: A carrier that did not participate on-exchange in the prior year but is joining exchanges for the given year. For 2014, these are carriers without individual experience in that state during 2013.

2016 2017

2016 2017

healthcare.mckinsey.com/reform

McKinsey Center for U.S. Health System Reform

Majority of consumers continue to have carrier choice, though the percentage seeing fewer carriers is increasing

25 states have 2 or more carriers participating in every county, while 5 states have only 1 carrier across all counties

2%13%

34%51%

18%

23%

38%

21%

1 participating carrier2 participating carriers

3-4 participating carriers5+ participating carriers

1 participating carrier2 participating carriers3-4 participating carriers5+ participating carriers

As of 11.03.2016

2013 pre-reform

307

307

No exchange

entry

100

2014 New

entrants

75

2014 exchanges

207

75

282

2015 exits

19

2015 new

entrants

70

2015exchanges

263

70

333

2016 exits

49

2016 new

entrants

31

2016 exchanges

284

31

315

2017 exits

89

2017 new

entrants

10

2017 exchanges

226

10

236

Incumbents Withdrawals New entrants

MARKET VIEWCount of carriers at the state level

There are fewer carriers participating across all carrier types in 2017, with national carriers declining most significantly

2014

282

75

24

28

50

64

41

2015

333

74

34

85

73

42

25

2016

315

73

14

35

77

74

42

2017

236

71

8

31

25

61

40

BlueCO-OPMedicaidNationalProviderRegional/local

Findings across 50 states and DC

1. Blues: a Blue Cross Blue Shield payor, includes Anthem, HCSC, Regence ; Consumer-operated-and-oriented plan (CO-OP): a recipient of federal CO-OP grant funding that was not a commercial payor before 2014 ; Medicaid: a carrier that offered only Medicaid insurance in the past, includes Molina and Centene, along with regional/local Medicaid carriers ; National: a commercial payor with a presence in more than four states that has filed on exchanges (specifically, Aetna/Coventry, Assurant, Cigna, Humana, UnitedHealthcare) ; Provider: a carrier that also operates as a provider/health system ; Regional/local: a commercial payor with a presence in four or fewer states (most often, just one state) that has filed on the exchanges.

2. This includes both subsidy-eligible (income below 400% of the federal poverty level (FPL)) and subsidy-ineligible (income above 400% FPL) consumers.

Carrier participation on exchange

QHP-eligible consumers seeing given number of carriers in their county

Carrier participation on exchange, by carrier type1

Exchange carrier participation by county