DES MOINES, Iowa (AP) – Iowa’s state insurance division says residents in 13 rural counties who want to buy subsidized health insurance under the Affordable Care Act will have just one option for a provider in 2017. Medica, a Minnesota-based carrier, is the only health insurer that has agreed to sell individual policies in the state via the Affordable Care Act’s online marketplace.

The Des Moines Register reports that about 55,000 Iowa residents bought individual health insurance policies for 2016 on the marketplace, and most had incomes low enough to qualify for subsidies, which come as tax credits. Counties that will only have Medica as an option include Adams, Buena Vista, Iowa, Jefferson, Keokuk, Lee, Louisa, Mahaska, Page, Pocahontas, Taylor, Van Buren and Wapello.

Insurance Commissioner Nick Gerhart says he’s worried that more counties could be served by just one provider next year.