Open enrollment for 2027 Affordable Care Act plans is still weeks away, but the list of which insurers will even be on the shelf is already shifting. Some companies are pulling back from marketplaces they judge too small or too costly to serve, while a smaller group is moving in the opposite direction, adding new states to their footprint. Both trends are unfolding at the same time, in the same market, for related reasons.
Six carriers see an opening
Six insurers have told regulators or investors they plan to enter new state marketplaces for plan year 2027. Insurers expanding into new territory are typically betting that a shrinking, sicker risk pool still leaves room for a well-priced plan to win market share, particularly in counties where an exiting competitor has left a gap, and in some states multiple insurers are announcing exits in the same market, precisely the kind of opening that draws a new entrant looking to establish a foothold before the next open enrollment period begins.
That count comes from KFF’s ongoing tracker of insurer participation changes, last updated September 15. The tracker groups insurers by parent company and draws on rate filings, CMS’s Qualified Health Plan Landscape File, and Mark Farrah Associates’ enrollment data rather than press releases alone, which is why the six-and-nine count can shift slightly as more states finalize their 2027 plan filings between now and open enrollment.
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Nine carriers are heading the other way
The same tracker counts nine insurers that have announced they will exit some or all of their current ACA marketplace states for 2027, a larger number than the group moving in. KFF ties the wave of exits directly to what happened after the enhanced premium tax credits expired at the end of 2025: enrollment fell sharply, and insurers that lose enrollees, especially healthier ones who are more likely to drop coverage when premiums rise, reassess whether a state market is still worth running. The result is a mixed picture rather than a uniform retreat, with entries concentrated in markets insurers see as underserved and exits concentrated where a company’s existing book of business has thinned out.
The largest single exit tracked so far belongs to Cigna, which is leaving the individual market entirely in all 11 states where it currently sells plans, both on- and off-exchange. Smaller regional carriers make up most of the rest of the exit list, often pulling out of a handful of counties rather than an entire state. That distinction matters for enrollees: a county losing its only marketplace insurer forces a switch to a different carrier’s network, while a county merely losing one of several options still leaves a choice, just a narrower one.
Why this matters before a single rate is finalized
None of this activity changes what a current enrollee pays on its own; separately, insurers that are staying in the market have proposed a median premium increase of about 15 percent for 2027, which would mark a second straight year of double-digit rate requests. The entries and exits do, however, determine how many plan choices show up on HealthCare.gov in a given county, and fewer competing insurers generally means less pressure on the ones that remain to hold prices down. KFF’s separate look at the 2026 plan year found that average marketplace premium payments net of tax credits already rose 58 percent that year, from $113 to $178 a month, as the subsidy cliff pushed higher-income enrollees out of the pool entirely. A market with fewer insurers heading into 2027 gives that same dynamic less room to correct itself at renewal time. State insurance departments still have to approve final 2027 rates before open enrollment, so the entry and exit list KFF is tracking, along with the rate requests behind it, can still change county by county before anyone actually shops for a plan.
Comparing coverage when carriers change
An insurer leaving or entering a county rarely comes with a personal notice explaining what to do next, and the appeal steps for a denied claim or a new prior-authorization request don’t change just because the carrier on the card did. Anyone comparing plans for the year ahead is doing so without a consistent baseline from one insurer to the next.
The Medicare Cost & Coverage Protection Kit is a 10-page kit with 51 state Medicare cost-help packs and the prior-authorization appeal steps, alongside the new Part D out-of-pocket cap.
Compare the coverage details in The Medicare Cost & Coverage Protection Kit.
This article was researched and drafted with the assistance of AI and reviewed by an editor.
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.
