This week, the Kaiser Family Foundation (KFF) released a new issue brief examining a recent hot topic—areas with few or no insurers participating in Affordable Care Act (ACA) marketplaces. KFF compared these areas to places where there are very few or no Medicare Advantage (MA) plans offered this year to people with Medicare.

Nationwide, there are currently 19 counties—in Nevada, Indiana, and Ohio—that will have no ACA marketplace plans for sale in 2018. This number has been shrinking as insurers fill some of the gaps, so it is possible each of these counties will have coverage in 2018.

By comparison, there are 147 counties across 14 states with no MA insurers this year. These counties are largely rural, and almost exclusively in the Western half of the United States, especially in areas where there are often very low population densities such as Alaska and Wyoming.

Upon inspection of areas at risk of having no exchange plans and areas without MA plans, KFF notes that “in 7 of these 19 counties, there are no Medicare Advantage insurers, and in another 8 counties, there are two or fewer firms now offering a Medicare Advantage plan – well below the national average.” KFF suggests that the lack of MA insurers in some of these regions might mean “that some markets are simply not attractive to private insurers.”

While there are differences between the MA and exchange markets, both use private insurers to provide health coverage. As KFF points out, “areas that historically have had difficulty attracting private insurers, which are often rural, may require a special approach” in order to guarantee access to health coverage options.

Read the KFF brief.