How Geography Affects Your Health Insurance Choices

The reality of the U.S. health insurance industry means you may not have much latitude to choose your provider. How much choice you have almost entirely depends on where you live.

Generally, if you’re in a big city in a densely populated state, a good number of insurers will be competing for your business. But in some rural areas, there may be a single dominant insurer. In fact, in 2010, a single insurer had gobbled up more than half the market for individual health care plans in 30 states, according to the Kaiser Family Foundation.

For example, if I lived in New York City and needed individual medical coverage, I could choose from more than 150 plans from at least a dozen health insurance companies on that state’s health insurance exchange. If I lived in Wheeling, W.Va., I could choose from 14 plans on the federal health exchange (used by many states, including West Virginia), all provided by a single insurer: Blue Cross Blue Shield.

The ACA aims to stimulate more competition across the country, and there are signs that’s happening in some small measure. In 2015, 86% of eligible individuals were able to choose from at least three insurers on the federal health exchange, an increase from 70% in 2014.

Still, that’s not the case in some parts of the country, where the best health insurance company for you may be the only one that will take your business. Aetna’s bid to acquire Humana and Anthem’s bid to buy Cigna could also significantly shrink choices nationwide.


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