United States · Health insurance · Flagship
Which US Marketplace Insurers Are Best, and Which Are Worst?
This ranks insurers on one thing: what a year actually costs on the plans they filed for 2026, in 409 counties of Florida, Texas and Ohio, for a single non-smoking 40-year-old [1,2]. It is a verdict about filings and nothing else. We have not measured how these companies pay claims, how wide their networks are or how they treat a customer on the phone, and a carrier that comes out badly here may be excellent at all three. On the measure we do have, UnitedHealthcare wins 568 of the 1,227 county-years priced, more than four times the next insurer [1], while the worst result belongs to an idea rather than a company: in 1,020 of those 1,227 county-years, the plan with the lowest monthly premium in the county is not the cheapest plan to own for the year [1]. Prices below are sticker, monthly with the annual figure beside them, before a premium tax credit that most buyers will get.
UnitedHealthcare
Holds the lowest total annual cost in 568 of 1,227 county-years, 46%, and the only insurer winning counties in Florida, Texas and Ohio alike [1]. Its own cheapest-premium plans are also the least punishing to follow, at a median of $938 [1]. Caveat: it is also the most widely filed insurer here, so it gets more chances to win than anyone else.
Best in one stateMedMutual
Wins 67 county-years, all of them in Ohio, and 63 are years of managing type 2 diabetes [1]. A specialist result rather than a broad one: on the chronic-care year it beats every carrier in its state, and on the other two it barely appears.
Worst cheap stickerCHRISTUS Health Plan
Where a CHRISTUS plan is the cheapest premium in a county, buying it costs a median of $4,353 more over the year than the best plan in that same county [1]. It holds the cheapest premium in 36 county-years and loses 24 of them. The plan that usually beats it is another CHRISTUS plan.
Loses every time it leadsOscar Insurance Company
Held the cheapest premium in 93 Texas county-years and was beaten on total cost in all 93, by a median of $4,060 [1]. No other insurer with a comparable sample has a clean sheet of losses.
Which insurers hold the lowest total annual cost most often
Across 1,227 county-years, being 409 counties of Florida, Texas and Ohio each priced for three different years of care, this is who sells the plan with the lowest total of premium plus that plan's own filed cost-sharing [1]. Twelve shown; 27 insurers win at least one.
| Insurer | County-years won on total cost | Share of 1,227 | States | Where those wins come from |
|---|---|---|---|---|
| UnitedHealthcare | 568 | 46% | FL, OH, TX | break an arm 146 · manage type 2 diabetes 234 · have a baby 188 |
| Oscar Health Insurance | 68 | 6% | OH | break an arm 31 · manage type 2 diabetes 6 · have a baby 31 |
| MedMutual | 67 | 5% | OH | break an arm 2 · manage type 2 diabetes 63 · have a baby 2 |
| Ambetter Health | 58 | 5% | FL | break an arm 35 · manage type 2 diabetes 21 · have a baby 2 |
| Blue Cross and Blue Shield of Texas | 54 | 4% | TX | break an arm 26 · manage type 2 diabetes 21 · have a baby 7 |
| Ambetter from Superior HealthPlan | 53 | 4% | TX | break an arm 17 · manage type 2 diabetes 16 · have a baby 20 |
| Oscar Insurance Company | 53 | 4% | TX | break an arm 31 · manage type 2 diabetes 0 · have a baby 22 |
| Molina Healthcare | 49 | 4% | FL, OH | break an arm 35 · manage type 2 diabetes 0 · have a baby 14 |
| Oscar Health Maintenance Organization of Florida | 40 | 3% | FL | break an arm 6 · manage type 2 diabetes 11 · have a baby 23 |
| Baylor Scott and White Health Plan | 37 | 3% | TX | break an arm 14 · manage type 2 diabetes 9 · have a baby 14 |
| Ambetter from Buckeye Health Plan | 36 | 3% | OH | break an arm 6 · manage type 2 diabetes 0 · have a baby 30 |
| CHRISTUS Health Plan | 24 | 2% | TX | break an arm 12 · manage type 2 diabetes 0 · have a baby 12 |
1. What this page is ranking, and what it is not
Every number here comes out of one calculation. Take a county, take every marketplace plan a single non-smoking 40-year-old can buy in it, add twelve months of premium to what that plan's own filed cost-sharing would charge for a year of care, and sort the result. Do that three times per county, for a simple fracture, a year of managing type 2 diabetes and a normal delivery, across all 409 counties of Florida, Texas and Ohio, and you have 1,227 county-years to rank insurers over [1,2].
That is a narrow thing to have measured. It says nothing about whether an insurer pays a disputed claim, how long it takes, which hospitals are in network, or whether the drug you take is on the formulary. Those are the questions most people would ask first, and no public filing answers them. What the filings do answer is what the plan will charge you if everything goes as written, and that turns out to be enough to separate insurers by a wide margin, because the gap between the best and the worst plan in a single county runs to thousands of dollars a year.
So: verdicts about filed prices for one buyer in three states. A carrier named badly below is being judged on the plans it priced lowest, in the counties where it priced them lowest, against other plans on the same shelf.
2. Best: the insurer that holds the lowest total cost most often
The table at the top of this page is the answer, and this is how to read it.
UnitedHealthcare wins 568 of the 1,227 county-years, which is 46% and more than four times the next insurer on it [1]. It is also the only one of the 27 winning insurers that takes counties in all three states. Its wins are spread across all three care years as well, at 146 fracture years, 234 diabetes years and 188 birth years.
The caveat belongs right next to the result. UnitedHealthcare files more plans in more rating areas than anyone else in this set, so it is on the ballot in counties where several of these insurers simply are not, and a win count rewards breadth as much as price. A fairer reading of the same table is that the second tier is regional by design: MedMutual's 67 wins are entirely Ohio and 63 of them are diabetes years, Ambetter Health's 58 are entirely Florida, and Blue Cross and Blue Shield of Texas's 54 are entirely Texas.
MedMutual is the sharpest specialist in the set. On a year of managing type 2 diabetes it holds the cheapest total in 63 Ohio county-years, and on the other two years it wins two apiece [1]. We cannot tell from the filings whether that is a deliberate pricing strategy or a side-effect of how its drug tiers happen to fall.
3. Worst: the cheap sticker that costs the most to follow
This is the table nobody selling insurance will publish, and it is the one worth reading twice.
The cheap-sticker table. For each insurer that held the cheapest premium in at least 20 county-years, what following that price costs over the year against the cheapest plan sold in the same county [1]. A high median is a statement about the plans that insurer prices lowest, not about the insurer's best plans, several of which appear in the table above.
| Insurer | County-years where its plan was cheapest on premium | How often that plan then lost | Median cost of following it | Worst single county-year |
|---|---|---|---|---|
| CHRISTUS Health Plan | 36 | 24 (67%) | $4,353 a year | $5,816 — Jefferson County, TX, a year in which you have a baby |
| Oscar Insurance Company | 93 | 93 (100%) | $4,060 a year | $6,022 — Brazoria County, TX, a year in which you have a baby |
| Anthem Blue Cross and Blue Shield | 45 | 43 (96%) | $3,717 a year | $5,794 — Allen County, OH, a year in which you have a baby |
| Ambetter from Buckeye Health Plan | 36 | 36 (100%) | $2,852 a year | $3,903 — Erie County, OH, a year in which you have a baby |
| Baylor Scott and White Health Plan | 30 | 30 (100%) | $2,769 a year | $4,199 — Bell County, TX, a year in which you manage type 2 diabetes |
| WellPoint | 30 | 30 (100%) | $2,758 a year | $4,851 — Hendry County, FL, a year in which you have a baby |
| Oscar Health Maintenance Organization of Florida | 48 | 42 (88%) | $2,722 a year | $6,995 — Pinellas County, FL, a year in which you have a baby |
| MedMutual | 27 | 18 (67%) | $2,213 a year | $5,471 — Champaign County, OH, a year in which you have a baby |
| Oscar Health Insurance | 66 | 66 (100%) | $2,107 a year | $5,584 — Butler County, OH, a year in which you have a baby |
| Antidote Health Plan of Ohio | 72 | 59 (82%) | $1,311 a year | $5,265 — Lorain County, OH, a year in which you have a baby |
| Ambetter Health | 105 | 104 (99%) | $984 a year | $6,152 — Lake County, FL, a year in which you have a baby |
| UnitedHealthcare | 441 | 295 (67%) | $938 a year | $6,958 — Webb County, TX, a year in which you have a baby |
| Ambetter from Superior HealthPlan | 48 | 48 (100%) | $612 a year | $684 — Calhoun County, TX, a year in which you break an arm |
| Blue Cross and Blue Shield of Texas | 78 | 73 (94%) | $517 a year | $5,792 — Rusk County, TX, a year in which you have a baby |
The measure is simple. When an insurer's plan is the cheapest premium in a county, how much does buying it cost you over the year against the cheapest plan actually available there? CHRISTUS Health Plan is worst at a median of $4,353, then Oscar Insurance Company at $4,060 and Anthem Blue Cross and Blue Shield at $3,717 [1].
Oscar Insurance Company is the starkest row for a different reason. It held the cheapest premium in 93 Texas county-years and lost on total cost in every single one of them, which no other insurer with a comparable sample manages [1]. Ambetter from Superior HealthPlan also loses all 48 of its leads, but by a median of $612, and a $612 miss is a rounding error beside a $4,060 one.
At the other end, UnitedHealthcare's cheapest-premium plans cost a median of $938 to follow over 441 county-years [1]. Blue Cross and Blue Shield of Texas is lower still at $517 across 78. Neither is a clean bill of health, since both lose most of the time they lead, but the amount at stake is an order of magnitude below the top of the table.
4. The worst individual choices, named
The widest gap between the cheapest-premium plan and the cheapest plan overall, in each state for each year of care, both plans named [1]. Ranked purely on size the list would be ten Florida birth years, eight of them the same pair of plans in adjacent counties, so it is cut one per state per year instead.
| County | In a year in which… | Cheapest premium in the county | Cheapest plan overall | Gap |
|---|---|---|---|---|
| Volusia County, Florida | you have a baby | Florida Health Care Plans, Gym Access IND Bronze HMO 1340 — $5,957 in premium; the year costs $16,167 | Oscar Health Maintenance Organization of Florida, Gold Elite Saver Plus | with AdventHealth — $7,473 in premium; the year costs $8,973 | $7,194 |
| Webb County, Texas | you have a baby | UnitedHealthcare, UHC Bronze Essential — $6,888 in premium; the year costs $17,548 | Ambetter from Superior HealthPlan, Complete Gold — $7,280 in premium; the year costs $10,590 | $6,958 |
| Allen County, Ohio | you have a baby | Anthem Blue Cross and Blue Shield, Anthem Bronze Pathway 10600 — $5,529 in premium; the year costs $16,189 | UnitedHealthcare, UHC Bronze Copay Focus $0 Indiv Med Ded — $6,435 in premium; the year costs $10,395 | $5,794 |
| Brazoria County, Texas | you manage type 2 diabetes | Oscar Insurance Company, Bronze Simple Breathe Easy with Enhanced… — $5,590 in premium; the year costs $10,770 | UnitedHealthcare, UHC Kelsey-Seybold Bronze Copay Focus $0… — $5,708 in premium; the year costs $6,408 | $4,362 |
| Allen County, Ohio | you manage type 2 diabetes | Anthem Blue Cross and Blue Shield, Anthem Bronze Pathway 10600 — $5,529 in premium; the year costs $10,949 | UnitedHealthcare, UHC Bronze Standard — $6,216 in premium; the year costs $6,916 | $4,033 |
| Santa Rosa County, Florida | you manage type 2 diabetes | Florida Blue HMO (a BlueCross BlueShield FL company), myBlue Bronze 26M01-23 — $6,921 in premium; the year costs $11,921 | UnitedHealthcare, UHC Bronze Standard — $7,516 in premium; the year costs $8,216 | $3,705 |
| Webb County, Texas | you break an arm | UnitedHealthcare, UHC Bronze Essential — $6,888 in premium; the year costs $9,688 | Ambetter from Superior HealthPlan, Everyday Gold — $7,150 in premium; the year costs $8,750 | $938 |
| Citrus County, Florida | you break an arm | Ambetter Health, Everyday Bronze — $6,221 in premium; the year costs $9,021 | Florida Blue (BlueCross BlueShield FL), BlueSelect Bronze 2139 — $6,915 in premium; the year costs $8,415 | $606 |
| Allen County, Ohio | you break an arm | Anthem Blue Cross and Blue Shield, Anthem Bronze Pathway 10600 — $5,529 in premium; the year costs $8,329 | Molina Healthcare, Molina Bronze Standard — $5,692 in premium; the year costs $7,892 | $437 |
Volusia County, Florida, in a year containing a birth, is the widest gap in the whole set. Florida Health Care Plans' Gym Access IND Bronze HMO 1340 has the lowest premium in the county at $5,957 a year, and once a normal delivery is priced through that plan's own filed cost-sharing the year comes to $16,167 on it. Oscar's Gold Elite Saver Plus with AdventHealth costs $7,473 in premium and $8,973 for the same year. The difference is $7,194 [1].
Ranked on size alone, the ten widest gaps in the data would be nine Florida birth years, eight of them the same two plans repeating across adjacent counties in one rating area [1]. That repetition is a fact about how rates are filed rather than a finding, so the table takes the worst case in each state for each year of care instead.
5. The most useful number on this page
In 629 of the 1,020 county-years where the cheapest-premium plan loses, the plan that beats it is sold by the same insurer [1]. Sixty-two percent.
That reframes the whole exercise. If you have decided on a carrier for reasons this page cannot measure, such as your doctor being in its network or a friend having had a good experience with it, you have probably not made the expensive mistake yet. The expensive mistake is made on the next screen, where the carrier's own plans are listed by monthly price and the one at the top is the one that costs you most over a year with anything in it.
If I had to give one instruction off the back of all 1,227 rows, it would be this: pick the carrier however you like, then refuse to pick the plan by premium.
6. The one verdict that is about a brand
Everything above is a verdict about plans. One finding in these files is genuinely about who filed it.
Filed cost-sharing entries that charge both a flat copay and a percentage coinsurance for the same service, by insurer, across all 28 states on the federal marketplace [1]. Ten shown of the twenty insurers filing the structure at all.
| Insurer | Filed entries charging both | Share of the 3,703 | Blue-branded |
|---|---|---|---|
| WellPoint | 996 | 27% | Yes |
| Blue Cross and Blue Shield of Texas | 988 | 27% | Yes |
| Anthem Blue Cross and Blue Shield | 888 | 24% | Yes |
| BlueCross BlueShield of South Carolina | 258 | 7% | Yes |
| Blue Cross and Blue Shield of Oklahoma | 146 | 4% | Yes |
| Priority Health | 109 | 3% | No |
| Blue Care Network of Michigan | 72 | 2% | Yes |
| Blue Cross and Blue Shield of Kansas | 49 | 1% | Yes |
| Blue Cross Blue Shield of Michigan Mutual Insurance Company | 47 | 1% | Yes |
| HealthPartners | 30 | 1% | No |
Some plans charge a flat copay AND a percentage coinsurance for the same service, on top of a deductible you have already paid. It is rare, at 3,703 entries out of the 541,504 filed for 2026, and 95% of those entries come from Blue-branded insurers: WellPoint at 996, Blue Cross and Blue Shield of Texas at 988, Anthem at 888 [1]. Thirteen of the twenty insurers using the structure at all are Blue Cross, Blue Shield, Anthem or WellPoint entities.
Nothing here is an accusation of bad faith. The structure is filed with the regulator, disclosed in the Summary of Benefits and Coverage, and lawful, and a plan using it may well be fairly priced for what it covers. What it is not is the copay-or-coinsurance model every explainer teaches, and because the filings are this concentrated a reader can act on the finding rather than merely note it: if you are shopping a Blue-branded plan in Texas or Florida, read the emergency room and inpatient rows in full before you look at the premium. The full count, by service and by state, is at the cost-sharing nobody reads.
7. Limits
Five of them, and they are load-bearing.
One buyer. Everything is priced for a single non-smoking 40-year-old with no dependants, and a family, a smoker or a 60-year-old would produce a different ranking, because age bands, tobacco loadings and household size all move the premium without moving the cost-sharing underneath it. Three states, because the CMS Public Use Files cover the federally-facilitated marketplace and nothing else, and the twenty-two states and the District of Columbia running their own exchange publish no plan-level data through that route at all [1]. Three stylised care years, which are comparable to each other and are not a forecast of yours. Sticker prices, before a premium tax credit that lowers every plan in a county by the same amount and rarely changes the order [1,3,4]. And no measurement at all of claims, networks, formularies or service.
Every plan named here is in the downloadable file behind this section, with its deductible, premium, out-of-pocket cost and total: 1,227 rows.
The county-level version of this argument is at what ranking by premium costs you, and the per-state tables are at Texas, Florida and Ohio.
Frequently asked questions
Which is the best health insurance company on the US marketplace?
Which insurer is worst?
What is the single worst plan choice in your data?
Is a cheap insurer always a bad insurer?
Are these rankings about claims, service or networks?
Why do some insurers appear twice under similar names?
Sources
Every figure on this page is footnoted to one of the primary documents below. Reliability tiers: A = regulator, court or filed document; B = reputable publisher or carrier official page; C = user-generated (reported by users).
- 1.Centers for Medicare & Medicaid Services — Qualified Health Plan Landscape and Benefits & Cost Sharing Public Use Files, plan year 2026. https://www.cms.gov/marketplace/resources/data/public-use-filesTier A · Regulator / court / filed document · Published 2026-08-01 · Accessed 2026-09-03
- 2.Best Worst Insurance — Annual cost of every marketplace plan in 409 counties, ranked two ways (PY2026). https://www.bestworstinsurance.com/data/us-health/county-plan-costs.csvTier A · Regulator / court / filed document · Published 2026-09-19 · Accessed 2026-09-19
- 3.Internal Revenue Service — Revenue Procedure 2025-25 — Applicable Percentage Table for 2026. https://www.irs.gov/pub/irs-drop/rp-25-25.pdfTier A · Regulator / court / filed document · Published 2025-07-18 · Accessed 2026-09-19
- 4.US Department of Health and Human Services, ASPE — 2025 Poverty Guidelines. https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelinesTier A · Regulator / court / filed document · Published 2025-01-17 · Accessed 2026-09-19