10. Nebraska

Blue Cross Blue Shield accounts for more than half of the Cornhusker State's market, while UnitedHealthcare has 19 percent.

Nebraska is also among the top ten states with the least competitive HMO markets (No. 6), as well as among the top ten states with the least competitive PPO markets (No. 9). 

(AP Photo/Nati Harnik)           

9. Wyoming

Cigna accounts for 55 percent of Wyoming's commercial health insurance market, and UnitedHealthcare accounts for 21 percent.

Wyoming also has the fourth least competitive HMO market.

 photo credit: www.CGPGrey.com

8. Rhode Island

Though ranked No. 8 among the worst competition overall, Rhode Island ranked first among states with the least competitive HMO markets. It also ranked second among the states with the least competitive POS markets.

There are two main health insurance companies in the state: Blue Cross Blue Shield, with 55 percent of the state's market, and UnitedHealthcare, with 30 percent.

(Photo: Matt York/Associated Press)

7. South Carolina

South Carolina is ranked fourth among the states with the least competitive PPO markets.

Blue Cross Blue Shield accounts for 60 percent of South Carolina's market share. Cigna accounts for 15 percent of the market.

(Photo: Visitors walk along the boardwalk in downtown Myrtle Beach. Bruce Smith/Associated Press)

6. North Dakota

North Dakota has the least competitive POS markets and the ninth least competitive HMO markets, according to the report.

Blue Cross Blue Shield accounts for 60 percent of the market. Aetna comes in at No. 2 with 26 percent.

(Photo: Tom Stromme/Associated Press)

5. Alaska

Premera, also part of Blue Cross Blue Shield, has most of the state's commercial health insurance market. They account for 62 percent of the market. A considerable chunk also belongs to Aetna, with 21 percent.

(photo credit: puttsk)

4. Delaware

Blue Cross Blue Shield accounts for 66 percent of Delaware's market. Aetna comes in at No. 2, with 19 percent.

Delaware also is ranked as the fifth worst state with the least competitive PPO market.

(photo credit: Delaware State Parks)

3. Michigan

Michigan has the second worst competitive PPO market.

Overall, Blue Cross Blue Shield of Michigan accounts for 69 percent of the market, while Priority Health is the second largest provider in the state with 9 percent of the state's share.

(Photo: The Associated Press)

2. Hawaii

Though Hawaii tops of lot of lists, this is one they don't want to be on.

America's healthiest place ranks third among states with the least competitive PPO, and second overall.

Most residents of the Aloha State have their health insurance through Hawaii Medical Service Association, a member of Blue Cross Blue Shield. They swallow up 69 percent of the competition, while Kaiser accounts for another 22 percent of the market share in the state.

(Photo credit: Liz Noffsinger)

1. Alabama

A single insurer. Blue Cross Blue Shield of Alabama, accounts for 88 percent of Alabama's commercial health insurance market. UnitedHealthCare accounts for 5 percent.

Alabama is rated first among states with the least competitive PPO markets; second among states with the least competitive HMO markets; and fourth among states with the least competitive POS markets.

(Photo: Associated Press/Dave Martin)