The Patient Protection and Affordable Care Act of 2010 (ACA) creates organized Marketplaces through which subsidized private insurance can be purchased by individuals who lack access to public or affordable employer coverage. Insurers' decisions to offer Marketplace plans in local markets (e.g., counties) have direct implications for the number and types of plans offered and premiums.

The study described in this policy brief aimed to identify differences between rural and urban counties in the number of Federally Facilitated Marketplace (FFM) insurers available to consumers and examine variation in the composition of insurers serving counties, focusing on group affiliation (e.g., Blue Cross Blue Shield, UnitedHealthCare, Humana, Cigna, Aetna) and ownership status.