Denial rates by state: Delaware to South Dakota
Every state that uses HealthCare.gov, ranked by the median in-network denial rate its Marketplace insurers reported to CMS for 2024. 84,505,217 of 451,278,167 in-network claims were denied across these 30 states (18.7%).
The full table
Median: the middle issuer in the state (each filing counts once). Pooled: all denied claims divided by all received claims (large issuers dominate). Appeals per 1,000 denials: how often members fought back. Overturned: the share of internal appeals the insurer decided in the member's favour.
| State | Issuers | Median issuer rate | Pooled rate | In-network claims | Denied | Appeals per 1,000 denials | Appeals overturned |
|---|---|---|---|---|---|---|---|
| 1. Delaware | 3 | 28.0% | 19.7% | 2,232,506 | 440,631 | 0.6 | 32.4% |
| 2. Oklahoma | 7 | 22.9% | 18.3% | 11,625,740 | 2,122,396 | 4.5 | 28.0% |
| 3. Alaska | 2 | 22.2% | 25.3% | 946,098 | 239,313 | 0.9 | 47.7% |
| 4. West Virginia | 2 | 21.8% | 21.0% | 3,184,929 | 669,877 | 1.7 | 9.4% |
| 5. Texas | 14 | 21.6% | 18.5% | 120,606,438 | 22,372,063 | 4.0 | 36.9% |
| 6. North Carolina | 7 | 21.5% | 19.9% | 23,717,695 | 4,713,568 | 1.4 | 27.2% |
| 7. Nebraska | 3 | 21.3% | 19.6% | 1,959,261 | 383,930 | 6.6 | 39.0% |
| 8. Iowa | 3 | 21.3% | 18.8% | 4,833,668 | 911,035 | 8.9 | 30.5% |
| 9. Arizona | 6 | 21.2% | 20.1% | 7,874,919 | 1,581,162 | 7.8 | 30.4% |
| 10. Mississippi | 4 | 21.1% | 18.3% | 14,872,712 | 2,725,739 | 0.6 | 14.2% |
| 11. Tennessee | 5 | 20.7% | 20.1% | 22,656,628 | 4,559,085 | 3.3 | 31.9% |
| 12. Florida | 11 | 20.2% | 22.2% | 82,397,280 | 18,256,139 | 0.7 | 36.7% |
| 13. South Carolina | 5 | 20.1% | 17.0% | 21,454,469 | 3,656,371 | 1.4 | 31.6% |
| 14. Ohio | 10 | 20.0% | 17.9% | 16,409,625 | 2,934,307 | 12.0 | 28.4% |
| 15. Michigan | 7 | 19.9% | 17.4% | 13,652,457 | 2,371,866 | 1.1 | 24.7% |
| 16. Missouri | 8 | 19.9% | 15.6% | 12,197,986 | 1,900,841 | 4.0 | 32.8% |
| 17. Kansas | 6 | 19.7% | 18.2% | 6,298,697 | 1,148,305 | 5.6 | 29.4% |
| 18. Alabama | 3 | 19.0% | 18.9% | 18,358,599 | 3,464,098 | 2.4 | 44.0% |
| 19. Utah | 5 | 18.7% | 18.6% | 9,574,435 | 1,781,829 | 3.6 | 26.9% |
| 20. Louisiana | 5 | 18.1% | 18.6% | 9,356,149 | 1,738,366 | 2.6 | 33.9% |
| 21. Indiana | 3 | 18.1% | 15.2% | 6,461,283 | 980,842 | 7.0 | 19.3% |
| 22. Wyoming | 1 | 17.6% | 17.6% | 1,305,051 | 229,909 | 1.9 | 39.9% |
| 23. Hawaii | 2 | 16.2% | 27.0% | 735,147 | 198,653 | 0.7 | 49.6% |
| 24. Arkansas | 6 | 15.8% | 15.9% | 17,922,408 | 2,848,075 | 4.2 | 24.7% |
| 25. North Dakota | 3 | 13.5% | 9.8% | 1,432,238 | 140,595 | 2.6 | 52.2% |
| 26. New Hampshire | 4 | 13.3% | 10.4% | 3,105,818 | 323,889 | 2.1 | 42.2% |
| 27. Montana | 2 | 11.5% | 11.6% | 2,012,739 | 234,099 | 6.4 | 25.6% |
| 28. Wisconsin | 12 | 10.8% | 12.1% | 9,824,576 | 1,188,325 | 1.8 | 49.9% |
| 29. Oregon | 6 | 10.2% | 10.9% | 2,552,164 | 277,498 | 4.6 | 31.7% |
| 30. South Dakota | 3 | 4.1% | 6.5% | 1,716,452 | 112,411 | 6.0 | 49.2% |
The ten highest and ten lowest issuer filings
| Highest reported denial rate | Rate | Claims |
|---|---|---|
| Imperial Insurance Companies, Inc. (TX) | 35.6% | 2,530 |
| Imperial Insurance Companies, Inc. (AZ) | 33.1% | 2,393 |
| Select Health of South Carolina (SC) | 32.6% | 121,039 |
| Community First Insurance Plans (TX) | 30.6% | 112,382 |
| Harvard Pilgrim Health Care of NE (NH) | 28.8% | 117,211 |
| CareSource North Carolina Co. (NC) | 28.3% | 158,212 |
| Celtic Insurance Company (DE) | 28.2% | 24,728 |
| AmeriHealth Caritas North Carolina, Inc. (NC) | 28.2% | 387,771 |
| Oscar Health Plan, Inc. (AZ) | 28.1% | 292,877 |
| AmeriHealth Caritas VIP Next, Inc. (DE) | 28.0% | 165,638 |
| Lowest reported denial rate | Rate | Claims |
|---|---|---|
| Avera Health Plans, Inc. (SD) | 2.7% | 436,009 |
| Providence Health Plan (OR) | 4.0% | 410,010 |
| Sanford Health Plan (SD) | 4.1% | 855,229 |
| Sanford Health Plan (ND) | 4.4% | 642,746 |
| Kaiser Foundation Health Plan, Inc. (HI) | 5.1% | 11,489 |
| HealthPartners Insurance Company (WI) | 6.5% | 466,789 |
| Capital Health Plan (FL) | 6.5% | 540,104 |
| Matthew Thornton Hlth Plan(Anthem BCBS) (NH) | 7.0% | 2,199,992 |
| Kaiser Foundation Healthplan of the NW (OR) | 7.3% | 9,923 |
| Healthy Alliance Life Co(Anthem BCBS) (MO) | 7.5% | 3,941,746 |
Issuer names as CMS prints them. Of 158 filings with at least 1,000 in-network claims, the reported denial rate runs from 2.7% to 35.6%: a nine-fold spread between insurers operating under the same federal rules. The file does not say why; it counts every denial reason, including duplicates and eligibility, and rates are self-reported.
Method
Source: Source: CMS Transparency in Coverage public use files. Issuer-level, self-reported, HealthCare.gov plans only; a denial includes duplicate, administrative and eligibility denials. Filings with fewer than 1,000 in-network claims are excluded from rankings. Stand-alone dental issuers are excluded. A state's median is computed over its issuer filings with at least 1,000 in-network claims; the pooled rate uses the same filings. HealthCare.gov states only; state-based marketplaces do not report to this file. Reproduce every number from the CSV below or from the issuer dataset.
Reuse this research
Free to cite, quote, chart and republish with attribution (CC BY 4.0). Every figure is reproducible from the downloads below.
Apellica (2026). Health insurance denial rates by state, 2024 claims. https://apellica.com/research/state-denial-rankings-2026
Corrections: editorial@apellica.com · Press: press@apellica.com · Nothing here predicts an individual claim; it describes populations.
General information, not legal or medical advice. Apellica is an appeal-preparation service, not a law firm.