OBJECTIVES: To examine the level of awareness and interest in the newly setup Health Insurance Marketplace under Affordable Care Act in West Virginia state of the United States of America. METHODS: Primary survey data were collected in July/August 2013 from a stratified sampling of West VirginiansA mail survey was completed by respondents in a cross-sectional study.  Key variables included general awareness of the Health Insurance Marketplace and the availability of subsidies, the individual mandate, interest in using the Marketplace, and perceptions of respondents’ ability to qualify for financial assistance. RESULTS: Six thousand surveys were mailed with a nine-page questionnaire. A total of 1,198 completed surveys were returned. Two months prior to launch, awareness of the Health Insurance Marketplace was low in WV; yet interest in the Marketplace was higher among those most likely to benefit—the insured and residents likely to qualify for financial subsidies. West Virginians reported being familiar with the individual mandate. CONCLUSIONS: Efforts should be increased at the federal, state, and local levels among government and non-government organizations to heighten awareness of the Health Insurance Marketplace in WV and, particularly, the availability of subsidies. Many, once made aware, expressed interest in learning more.