At least a dozen health insurers have told regulators they will stop selling ACA Marketplace plans in one or more states after this year, a wave of exits that will force hundreds of thousands of people to pick a new health plan for 2027. The departures come as rising costs and the loss of extra subsidy money are already reshaping what Marketplace coverage costs, and in some counties, the exits will leave shoppers with only a single insurer to choose from. For people who buy their own coverage because they are retired early or self-employed, an insurer leaving the market can mean losing a plan and a network of doctors they were counting on.
The Insurers Leaving and Who They Cover
According to healthinsurance.org’s tracking of 2027 Marketplace exits, updated August 4, 2026, Cigna will not offer Marketplace coverage in any state next year, ending plans that currently cover about 369,000 enrollees across 11 states including Arizona, Colorado, Florida, Georgia, and Illinois. CareSource is dropping its Marketplace plans in West Virginia, Ohio, and Indiana, affecting roughly 60,000 people in Indiana and more than 28,000 in Ohio. PacificSource is exiting Idaho, Montana, and Oregon, where a combined 60,000 people currently hold its plans, Molina Healthcare is shrinking its Marketplace footprint from 14 states to six, and Baylor Scott & White Health Plan’s exit affects about 100,000 enrollees in Texas.
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Fewer Choices in More Places
The practical effect of so many insurers leaving at once is a shrinking set of options in the counties they used to serve. Single-insurer counties — places where shoppers can pick from only one Marketplace carrier — have climbed to 165 nationwide, up sharply from 93 just a year earlier, according to healthinsurance.org’s analysis. A shopper in one of those counties does not lose Marketplace coverage outright, since federal rules require a replacement option to exist, but they do lose the ability to compare competing plans and networks, which had helped keep both prices and provider access in check in more competitive markets.
Why Insurers Are Pulling Back Now
The exits are unfolding at the same time Marketplace insurers who are staying are proposing double-digit premium increases for 2027, and the two trends share a root cause. The enhanced premium tax credits that had subsidized ACA coverage expired at the end of 2025, pushing healthier, price-sensitive enrollees out of the market and leaving insurers with a smaller, sicker pool of remaining customers. Combined with federal regulatory changes affecting how plans are priced and sold, several carriers concluded that continuing to compete in certain state markets was no longer financially worthwhile, opting to exit rather than raise prices even further and risk losing money regardless.
Part of a Longer Pattern, But Not a Typical Year
Insurer participation in the ACA Marketplace has fluctuated for years, with carriers routinely entering and leaving individual state markets as they reassess profitability. What sets the current round of exits apart, according to healthinsurance.org’s analysis, is that it is arriving amid growing uncertainty driven simultaneously by higher premiums, declining enrollment, and federal rule changes — three forces reinforcing each other rather than one isolated pressure a single insurer might absorb and stay put. A carrier that might have tolerated a single bad year in a state market is instead facing rising costs, a shrinking customer base as healthier enrollees leave, and new federal requirements at the same time, and several concluded that the combination made continued participation in certain states not worth it heading into 2027.
What Enrollees in an Exiting Plan Need to Do
Anyone whose current Marketplace insurer is leaving their state will not be automatically enrolled in a replacement plan with the same terms; instead, Marketplace rules typically default affected enrollees into a similar plan from a remaining insurer unless they actively choose something else during open enrollment. That makes shopping around during open enrollment more important than usual for anyone affected, since a default reassignment may carry a different premium, deductible, or provider network than the plan they are used to. Coverage under a new plan takes effect January 1, 2027, provided enrollees complete their selection during the open enrollment window that precedes it. Anyone unsure whether their current plan is among those exiting can check directly with their insurer or state exchange rather than waiting for a notice to arrive, since mailed notifications can be delayed or, in a household that has moved recently, sent to an old address.
A Market in Flux Heading Into 2027
Taken together, the insurer exits and the double-digit rate increases proposed elsewhere in the Marketplace point to a coverage year in which shoppers will need to actively re-shop rather than assume their current plan will simply renew on similar terms. KFF’s ongoing tracking of insurer participation changes for the 2027 plan year shows the list of exits is still being finalized as more carriers file their final 2027 offerings with state regulators, meaning the count of affected enrollees could still grow before open enrollment begins.
The Help That Isn’t Advertised
Separately, a disrupted health plan is not the only cost squeezing older households heading into next year. SNAP for people 60 and older, weatherization assistance, and senior property-tax freezes each offer real relief, but none of them enroll anyone automatically — every one of them requires an application.
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This article was written with the assistance of AI and reviewed for accuracy before publication.
David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
