Many on ACA plans face a new crisis in 2027: Insurers fleeing the market

An ACA marketplace is a state or federal shopping platform for people who do not get health insurance through an employer or another program. They compare plans, prices, networks, and coverage during open enrollment. An insurer leaving means it will no longer sell ACA plans in a state or marketplace.

For example, Cigna is leaving all 11 states where it offers ACA plans. More than 350,000 Cigna ACA enrollees may need to select different coverage. Courtney Mroch, who has diabetes, asthma, and a history of cancer, is already worried about who will cover her in 2027.

The change does not automatically mean people lose coverage immediately, but it can require them to switch plans for the next year. Fewer insurers can mean fewer prices, doctors, and benefit designs. People with chronic illnesses may face disrupted care if their current doctors are not included in replacement networks.

Insurers are proposing average ACA marketplace premium increases of about 15% for 2027. That would be the second consecutive year of double-digit increases. Premiums are the regular amounts people pay to keep coverage, whether or not they use medical services.

At least 11 insurers have announced plans to leave marketplaces in some states where they currently operate. Six insurers have announced plans to enter new marketplaces. Cigna is the largest example described: it plans to exit all 11 states where it offers ACA plans and has more than 350,000 ACA enrollees.

The overall direction is more exits than entries. KFF reached these figures by examining public insurer filings across all 50 states and Washington, D.C. For consumers, the result could be fewer plans, more switching, and higher monthly costs, although the exact premium change will vary by person and location.

When an insurer exits, its customers generally must compare and choose another available plan for the next coverage year. The replacement may have a different premium, deductible, provider network, or covered services. Fewer insurers also mean fewer plan choices and price points.

Miranda Yaver warned that a doctor may not accept any of the remaining options. That matters greatly for someone managing diabetes, asthma, cancer follow-up, or another chronic condition. Courtney Mroch’s concern illustrates the stakes: she already pays $1,250 monthly for a silver plan and does not know who will cover her in 2027.

The practical result can be discontinuity in care and coverage. A person may need to change doctors, pay more to keep a lower deductible, or accept less suitable coverage. If no available price works, some people may consider going uninsured, as Denise O’Connor’s husband is considering temporarily.

Enhanced ACA tax credits reduced what many people paid for marketplace coverage. After they expired at the end of 2025, enrollment fell by roughly 3 million. The article explains that some healthier people responded by dropping insurance or moving to cheaper plans with worse coverage.

People who remained were more likely to have greater health needs and higher medical costs. That changes the marketplace’s mix of customers. Insurers collect premiums from everyone, but medical claims can be much higher for people who need regular treatment, medicines, testing, or hospital care.

With healthier customers leaving, the remaining pool can become more expensive to insure. Jennifer Chumbley Hogue said rising healthcare costs and this enrollment pattern can make marketplaces less profitable. Insurers may then seek higher premiums or leave markets altogether, creating fewer choices for the people who still need coverage.

When a plan disappears, people can compare the marketplace options still available in their area. They can also work with an insurance broker, as Denise O’Connor plans to do. Some may choose a cheaper non-ACA plan, while others may briefly go uninsured until they qualify for another source of coverage.

These choices involve trade-offs. A lower monthly premium may come with a higher deductible or less protection when care is needed. A replacement plan may exclude a preferred doctor from its network. Cheaper coverage may also cover fewer services or provide less comprehensive benefits. Mark Lathrop, who needs an annual MRI, wants a lower deductible because the scan costs $2,400.

The article gives stark examples. O’Connor’s husband is considering six weeks without insurance before Medicare. Lathrop faces about $17,600 for comparable coverage, up from $16,000, while Mroch pays $1,250 monthly for her silver plan.

A premium is the regular amount paid to keep an insurance plan active. A deductible is the amount a person generally pays for covered care before the plan begins paying many benefits. A provider network is the group of doctors, hospitals, and other healthcare providers that accept a plan’s coverage terms.

The article shows why these features must be considered together. Mark Lathrop needs an annual MRI for a spinal cord injury. Because the scan costs $2,400, he considers a plan with a lower deductible more important, even though another plan might have a cheaper monthly premium.

A low premium does not guarantee affordable care. A plan can cost less each month but require more spending when someone receives treatment. It may also exclude a preferred doctor or offer fewer covered services. For people with chronic conditions, those limits can interrupt established care and make the apparent bargain expensive overall.

Health insurance pooling works by combining many enrollees’ premiums to help pay the group’s medical claims. Healthy people may use little care in a year, while others need expensive medicines, tests, or treatment. The broad mix makes costs more predictable for the insurer and the group.

The article describes what happens when that balance weakens. After enhanced tax credits expired, some healthier people dropped coverage or moved to cheaper, worse plans. People who stayed tended to have greater health needs and higher medical costs. Their claims can consume more of the premiums collected across the pool.

That pattern can make marketplace coverage less profitable as healthcare costs rise. Insurers may propose higher premiums to cover expected claims. Some may also leave markets, reducing competition and choice. In 2027, KFF found 11 announced insurer departures but only six announced entries, showing how a weaker pool can affect the entire marketplace.