By Sohaib Shams
Eleven health insurers have announced plans to exit Affordable Care Act marketplaces in 2027, while average premiums are projected to jump about 15% — the second consecutive year of double-digit increases. The departures coincide with open enrollment beginning Sunday in most states, giving millions of Americans roughly two months to select coverage for next year amid shrinking options and rising costs.
Premiums surge as insurers exit
An analysis by KFF, a nonpartisan health policy research group, found insurers across all 50 states and Washington, D.C., are proposing an average 15% premium increase for 2027. At the same time, 11 insurers plan to leave at least some state marketplaces, including Cigna, which will withdraw from all 11 states where it offers ACA plans, affecting more than 350,000 enrollees. Only six insurers have announced plans to enter new markets. "The main takeaway is that more insurance companies are leaving the marketplace than coming in," said Cynthia Cox, director of the ACA program at KFF.
Consumers face disruption
The changes threaten to disrupt care for people like Courtney Mroch, a 56-year-old Nashville resident with diabetes, asthma and a history of cancer. Her Cigna silver plan costs $1,250 a month, up from $850 in 2025 — more than her mortgage. In Colorado, Denise O'Connor saw her family's premium more than double to about $2,300, forcing them to tap retirement savings. Mark Lathrop in Idaho faces a comparable 2027 plan costing $17,600, up from $16,000, and needs a low-deductible plan for annual MRI monitoring. "This is going to create a lot of discontinuities in care and coverage for people," said Miranda Yaver, assistant professor of health policy at the University of Pittsburgh. "If you have a doctor who doesn't accept the fewer number of options available to you, that can be very disruptive."
Why insurers are leaving
The exodus follows the expiration of enhanced tax credits at the end of 2025, which caused ACA enrollment to drop by roughly 3 million. Healthier individuals moved to cheaper, less comprehensive coverage or dropped insurance altogether, leaving a sicker, costlier pool. Rising healthcare costs further squeeze insurer margins, said Jennifer Chumbley Hogue, a Texas insurance broker. Cigna spokesperson pointed to CEO Brian Evanko's April comments that exiting the ACA marketplace aligns with positioning the company's "core healthcare businesses for sustainable growth." PacificSource, another departing insurer, said its decision was made to "continue fulfilling our mission and serving members for the long term amid growing pressures across the healthcare industry."
Impact on ACA support
Experts warn the turmoil could erode public backing for the ACA. A recent KFF poll showed overall favorability fell to 58% from 64%. "We don't see the repeal and replace of 2017, but we're making it much harder for patients to remain on these plans," Yaver said. Hogue urged enrollees to actively compare plans during open enrollment rather than rely solely on mailed notices, as premiums and subsidies may differ from those letters.
