ACA insurers exit states as premiums rise 15%

The open enrollment period for the Affordable Care Act begins Sunday in most states, giving consumers roughly two months to select health plans for 2027. Many buyers face a shrinking market, with eleven insurance companies announcing plans to exit ACA markets in at least some states next year.

KFF, a nonpartisan health policy research group, analyzed public insurance documents from all 50 states and Washington, D.C. The analysis found that insurers are proposing average premium increases of approximately 15% for 2027. This marks the second consecutive year of double-digit premium hikes.

Cigna, which serves more than 350,000 ACA enrollees, is withdrawing from all eleven states where it currently offers plans. Six other insurers have announced plans to enter new markets. Cynthia Cox, director of the ACA program at KFF, stated that the primary takeaway is that more insurers are leaving the market than entering it.

The exits follow the expiration of extended tax credits at the end of 2025. This change caused ACA enrollment to drop by approximately 3 million people. Jennifer Chumbley Hogue, an insurance broker in Texas, noted that healthier individuals moved to cheaper coverage or dropped insurance entirely. Consequently, those who remained tend to have higher medical needs and costs, reducing the market's profitability for insurers.

Miranda Yaver, an associate professor of health policy and management at the University of Pittsburgh, warned that these changes will create discontinuities in care. She explained that if a patient's doctor does not accept the reduced number of available options, the disruption is severe, especially for those with chronic conditions. Yaver added that if the few remaining prices do not work for consumers, some may choose to remain without coverage.

Courtney Mroch, a 56-year-old Nashville resident with diabetes and asthma, pays $1,250 monthly for a silver-level plan. This represents an increase from $850 in 2025. Mroch noted that her premium now exceeds her family's mortgage payment. Her husband enrolled in a cheaper, standalone plan outside the ACA to manage costs. "Quién sabe quién me cubrirá en 2027 o cuánto más costará," Mroch said.

In Colorado, Denise O’Connor and her husband saw their monthly premiums more than double this year, rising from slightly over $900 to approximately $2,300. The couple, also covered by Cigna, had to dip into retirement savings. O’Connor plans to work with a broker to find a new plan. Her husband is considering going uninsured for six weeks until he becomes eligible for Medicare. "Es una preocupación," he said. "Está sano, pero cualquier cosa puede pasar en cualquier momento."

Mark Lathrop and his wife in Idaho are seeking new coverage after PacificSource decided to exit the ACA market. The couple does not qualify for standard ACA subsidies. Lathrop stated that a comparable plan for 2027 would cost around $17,600, up from about $16,000 last year. He requires an annual MRI to monitor a spinal cord injury, which costs $2,400, making a lower deductible essential. A PacificSource spokesperson said the decision was not made lightly and aims to ensure the company can continue serving members in the long term.

A KFF survey found that favorable views of the ACA dropped to 58% from 64%. Yaver said the changes make it harder for patients to stay in plans, potentially weakening the law without formal repeal. Hogue advised enrollees to review their options when open enrollment starts rather than relying solely on mailed notices. She noted that premiums and available subsidies may differ from the amounts listed in those letters. "Vale la pena dedicar cinco minutos a echarle un vistazo," Hogue said.