Health insurance by state
All 51 states and the District of Columbia, 3,143 counties. Uninsured rates, how many people a subsidy would reach, and which states leave people in the gap.
Every state and the District of Columbia, 3,143 counties in all. The federal government publishes two different files about this, and they cover different states, so the tables below carry different columns. Both are ordered by uninsured rate.
States where county-level marketplace data is published
For these 26 states the CMS Open Enrollment file publishes insurer counts, plan counts and enrollment county by county, so their pages carry all of it.
| State | Medicaid | Uninsured | Plans per 1,000 | Insurers | County pages |
|---|---|---|---|---|---|
| Texas | Not expanded | 19.1% | 159 | 1–10 | 43 |
| Oklahoma | Expanded | 14.4% | 79 | 1–7 | 5 |
| Florida | Not expanded | 13.7% | 254 | 1–13 | 34 |
| Arizona | Expanded | 12.9% | 60 | 1–7 | 8 |
| Wyoming | Not expanded | 12.5% | 86 | 2–2 | 2 |
| Mississippi | Not expanded | 12.1% | 137 | 3–5 | 6 |
| Alaska | Expanded | 12.1% | 46 | 2–2 | 3 |
| Tennessee | Not expanded | 11.3% | 98 | 3–5 | 14 |
| South Carolina | Not expanded | 11.2% | 138 | 2–5 | 14 |
| Montana | Expanded | 11.1% | 83 | 3–3 | 4 |
| North Carolina | Expanded | 10.2% | 87 | 2–6 | 25 |
| Kansas | Not expanded | 10.1% | 81 | 1–5 | 5 |
| Alabama | Not expanded | 10.0% | 114 | 2–4 | 12 |
| South Dakota | Expanded | 9.9% | 70 | 2–3 | 3 |
| Utah | Expanded | 9.3% | 127 | 2–5 | 6 |
| Missouri | Expanded | 9.2% | 74 | 2–6 | 12 |
| Louisiana | Expanded | 9.2% | 82 | 2–5 | 13 |
| Indiana | Expanded | 9.1% | 54 | 3–5 | 14 |
| Nebraska | Expanded | 8.2% | 79 | 5–5 | 3 |
| Ohio | Expanded | 8.1% | 50 | 3–9 | 25 |
| North Dakota | Expanded | 6.5% | 64 | 2–3 | 3 |
| Iowa | Expanded | 6.4% | 48 | 2–5 | 7 |
| Oregon | Expanded | 6.4% | 36 | 5–6 | 8 |
| Wisconsin | No gap* | 6.4% | 62 | 1–5 | 14 |
| Michigan | Expanded | 6.2% | 62 | 2–7 | 19 |
| New Hampshire | Expanded | 5.5% | 58 | 4–4 | 4 |
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release.
States where it is not
For these 25 the CMS county file carries no insurer or plan counts. Mostly that is because the state runs its own exchange, but not always — a few are on HealthCare.gov and simply do not appear in that file, so the column below says where each one actually enrolls rather than leaving you to infer it. What Census publishes for every county in the country is who is uninsured and what they earn, which is the more useful half anyway: it says how many people a premium tax credit would actually reach.
| State | Where you enroll | Medicaid | Uninsured | In subsidy range | County pages |
|---|---|---|---|---|---|
| Georgia | Georgia Access | Not expanded | 14.0% | 629,756 | 30 |
| Nevada | Nevada Health Link | Expanded | 13.7% | 197,559 | 2 |
| New Mexico | beWellnm | Expanded | 13.4% | 107,678 | 5 |
| Arkansas | Arkansas Health Insurance Marketplace (enrolls via HealthCare.gov) | Expanded | 11.3% | 140,289 | 7 |
| Idaho | Your Health Idaho | Expanded | 11.1% | 98,673 | 5 |
| Colorado | Connect for Health Colorado | Expanded | 9.3% | 229,624 | 11 |
| New Jersey | Get Covered New Jersey | Expanded | 9.0% | 330,684 | 19 |
| Delaware | HealthCare.gov | Expanded | 8.3% | 33,350 | 3 |
| Illinois | Get Covered Illinois | Expanded | 8.1% | 423,655 | 19 |
| Virginia | Virginia's Insurance Marketplace | Expanded | 8.1% | 283,998 | 20 |
| Kentucky | kynect | Expanded | 8.1% | 146,636 | 8 |
| Washington | Washington Healthplanfinder | Expanded | 7.8% | 256,620 | 14 |
| West Virginia | HealthCare.gov | Expanded | 7.3% | 48,679 | 3 |
| Pennsylvania | Pennie | Expanded | 7.2% | 360,928 | 31 |
| Maryland | Maryland Health Connection | Expanded | 7.2% | 176,483 | 15 |
| Maine | CoverME.gov | Expanded | 7.2% | 39,094 | 5 |
| Connecticut | Access Health CT | Expanded | 7.0% | 95,936 | 9 |
| California | Covered California | Expanded | 6.9% | 1,173,956 | 36 |
| Minnesota | MNsure | Expanded | 6.0% | 140,120 | 12 |
| New York | NY State of Health | Expanded | 5.9% | 429,201 | 27 |
| Rhode Island | HealthSource RI | Expanded | 5.3% | 22,701 | 3 |
| Vermont | Vermont Health Connect | Expanded | 5.1% | 12,685 | 1 |
| District of Columbia | DC Health Link | Expanded | 4.8% | 11,210 | 1 |
| Hawaii | HealthCare.gov | Expanded | 4.1% | 23,939 | 3 |
| Massachusetts | Massachusetts Health Connector | Expanded | 3.3% | 84,846 | 11 |
"In subsidy range" counts uninsured under-65 residents earning 138–400% of the federal poverty level. Source: US Census Small Area Health Insurance Estimates.
*Wisconsin has not adopted the ACA expansion but covers adults below the poverty guideline through its own program, so it has no coverage gap. Medicaid status verified against the KFF expansion tracker.
9 of these states have a coverage gap
Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas and Wyoming have not adopted the Medicaid expansion. In those states an adult below 100% of the federal poverty guideline generally qualifies for neither Medicaid nor a premium tax credit — because the credit was written assuming Medicaid would cover them, and it does not.
It is the sharpest state-level difference in this system, and it is why a national article about health insurance cannot tell you what you need to know.
Nine states have not published 2027 enrollment dates
A federal rule that would have shortened Open Enrollment was vacated by a court in June 2026, and state marketplaces spent the summer reverting. As of 2026-09-01, District of Columbia, Georgia, Illinois, Maine, Maryland, New Mexico, New York, Rhode Island and Vermont had not published confirmed 2027 dates. Their pages say so rather than printing a deadline we cannot source. What changed.
Why state pages, when plans are sold by county
Because some things genuinely are set at state level: whether Medicaid was expanded, who runs the marketplace, and the rating areas the state drew. Price and plan choice are county-level, which is what the county pages are for.