Document Type

Policy Brief

Publication Date



CO-OPs, rural, insurance, access, Maine Rural Health Research Center, health insurance, MRHRC, Access/Insurance


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 available.

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 product availability.

Key Findings:

  • 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 counties.

Funding Organization

Federal Office of Rural Health Policy, Health Resources and Services Administration, US Department of Health and Human Services

Grant Number




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