11 Insurers Plan to Leave ACA Marketplaces for 2027 as Average Premiums Rise About 15%, With Open Enrollment Starting Sunday

Since the enhanced premium tax credits expired at the end of 2025, the Affordable Care Act marketplaces have lost roughly 3 million enrollees. Now the insurers are following them out. As of Oct. 28, KFF counts 11 carriers that have announced exits from the 2027 marketplaces, in some or all of the states where they sell plans. Fewer insurers are entering than leaving: NBC News, citing KFF, reports six insurers have announced plans to enter new marketplaces. KFF's own brief puts the number of entrants at seven. By either count, more companies are leaving than coming in.

Open enrollment begins Sunday, Nov. 1 in most states and runs about two months.

Who is leaving

Cigna is the biggest name. It will exit all 11 states where it sells ACA plans, covering more than 350,000 on-exchange enrollees at its first-quarter count. Medical Daily puts the figure at about 369,000. The states are Arizona, Colorado, Florida, Georgia, Illinois, Indiana, Mississippi, North Carolina, Tennessee, Texas and Virginia.

KFF says Cigna decided to leave the individual market to focus on other segments, citing a lack of potential to grow its ACA business.

Other exits include Baylor Scott & White Health Plan in Texas, with about 100,000 marketplace enrollees. CareSource is leaving Indiana, Ohio and West Virginia. PacificSource is leaving Idaho, Montana and Oregon, and Providence Health Plan is leaving Oregon. Medica is leaving Iowa, Kansas and Oklahoma, and UnitedHealthcare is leaving Georgia.

Molina is leaving Illinois, Ohio, Mississippi and Kentucky. It plans to shrink its individual market footprint from 14 states to six. A separate tally on healthinsurance.org, last updated Oct. 8, counts at least a dozen exiting insurers.

CMS documents show HealthCare.gov will have 152 participating insurers in 2027, down 14% from this year, according to The Washington Sun. The same documents show the average enrollee will still see plans from five or six insurers. Those figures cover the 29 states that use HealthCare.gov.

Premiums up again

Insurers are proposing an average increase of about 15% for 2027, according to KFF's review of public filings in all 50 states and D.C. A Washington Post analysis of finalized and proposed rates also found about 15%. It is the second straight year of double-digit hikes.

The averages hide wide variation. In New Jersey, the state Department of Banking and Insurance says individual-market rates will rise a weighted average of 19.8% in 2027, after 15.9% this year. Those are pre-subsidy figures, and what a household pays depends on income, plan and eligibility for aid. CMS figures cited by The Washington Sun put the average increase for the most popular HealthCare.gov plans at 11%.

Insurers cite labor shortages and rising costs tied to GLP-1 drugs. Matt McGough, a KFF policy analyst, said the underlying cost of healthcare is the first driver. Neil Sullivan, a former New Jersey assistant insurance commissioner, said a sicker risk pool full of high utilizers pushes premiums up.

KFF says the enrollment drop affects the size of the market and potentially the risk pool, if healthier people are the ones leaving. It adds that insurers may reassess profitability as people leave.

Courtney Mroch, a 56-year-old Nashville cancer survivor with diabetes and asthma, pays $1,250 a month for a silver plan, up from $850 in 2025. Cigna is leaving her state. "Who knows who will cover me in 2027 or how much more it'll cost," she said.

What happens to people whose insurer leaves

In most HealthCare.gov states, people who do nothing will be moved into a comparable plan from another company. The site says it will "re-enroll you in a comparable one with a different insurance company." Comparable does not mean the same doctors, hospitals or drug lists.

The rules differ by state. In Connecticut, ConnectiCare enrollees must pick another insurer's plan themselves to keep marketplace coverage, according to healthinsurance.org. Oregon is moving from HealthCare.gov to its own exchange.

Miranda Yaver, an assistant professor of health policy and management at the University of Pittsburgh, said fewer options will create "a lot of discontinuities in care and coverage," especially for people with chronic illness. Jess Settle, a 39-year-old in Rappahannock County, Virginia, pays $400 a month and loses her insurer on Dec. 31. She doubts she can pay more.

The political fight

Democrats blame Congress's decision to let the enhanced credits lapse. Last year's extended government shutdown centered partly on that fight. House Minority Leader Hakeem Jeffries and Rep. Jason Crow have said Democrats want to reinstate the subsidies to bring premiums under control. A House bill that Rep. Tom Kean Jr. (R-N.J.) voted for never got traction in the Senate. Republican leaders opposed an extension.

The administration and Republicans point to fraud instead. CMS Administrator Dr. Mehmet Oz has said as many as 35% of ACA enrollments might not be legitimate and that "fraud will destroy Obamacare." Vice President JD Vance told Breitbart News that fraud is definitely making health care more expensive. The administration has been removing enrollees it believes are fraudulent. None of the cited material quantifies how much of the 2027 premium increase comes from that cause.

The Washington Post reports that roughly another 5 million people could lose ACA coverage by the end of 2026, citing rising costs, the lingering effect of lost subsidies and new restrictions imposed by the Trump administration.

More pressure is coming. Medicaid work-reporting requirements take effect in January 2027, according to economist Neale Mahoney. Employer plans are also getting pricier. Mercer projects an 8.2% rise in per-employee health benefit cost in 2027, the steepest since 2003.

For households in exiting insurers' territory, the deadline is concrete. Coverage ends Dec. 31, and the choice of whether to accept an automatic match or shop for a plan has to be made once enrollment opens Sunday.