Created by the Affordable Care Act (ACA), Consumer
Operated and Oriented Plans (CO-OPs) are private,
non-profit health insurers that were designed to increase
insurance plan choice and lower premiums in the Health
Insurance Marketplaces. Early analyses of the ACA
suggested that CO-OPs may be particularly beneficial for
rural communities, where fewer individual and small group
health insurance options have traditionally been
This Research and Policy Brief, authored by research
staff at the Maine Rural Health Research Center, explores
the early availability and role of CO-OPs in rural and
urban counties. We describe the regional distribution and
market prevalence of CO-OP products in rural and urban
counties and compare the number of products available in
counties with and without CO-OP plans in 2014 and 2015.
We also examine the proportion of lowest cost silver
products for 27 year olds offered by CO-OPs in both
years. To better understand the impact of CO-OP closures
on consumer choice in the 2016 Marketplaces, we examine
how these closures may have affected the prevalence of
CO-OP products in rural versus urban counties and overall
- CO-OPs represented a larger overall share of
Marketplace products available in rural versus urban
counties in 2014 and 2015.
- From 2014 to 2015, CO-OP products increased in
absolute numbers and grew modestly as a proportion of
offerings in both rural and urban counties.
- In 2014 and 2015, CO-OPs were more likely to offer
the lowest cost silver product available for purchase in
rural counties than in urban counties.
- Recent closures of CO-OPs are likely to
disproportionately reduce product availability in rural