A wave of insurer exits is reshaping the Affordable Care Act marketplace for 2027, and the trigger traces back to a subsidy that lapsed quietly at the end of last year. The enhanced premium tax credits that had lowered marketplace premiums for millions of enrollees expired on December 31, 2025, and insurers responding to the resulting enrollment and pricing shifts have begun pulling out of state markets ahead of the 2027 plan year. For adults in their late fifties and early sixties who buy coverage on the marketplace before Medicare eligibility begins, the list of available plans in some counties is shrinking at the same time premiums are rising.
What the Enhanced Premium Tax Credit Actually Did
The enhanced credits, layered on top of the ACA’s original premium tax credit structure, had extended subsidy eligibility further up the income scale and increased the subsidy amount for lower earners. Their expiration at the end of 2025 raised the net premium many enrollees pay out of pocket.
According to KFF’s marketplace tracker, marketplace sign-ups fell by more than a million between the 2025 and 2026 open enrollment periods as a direct result.
Insurers set their 2027 rates and participation decisions with that smaller, and differently composed, enrollee pool in mind. When healthier or more price-sensitive enrollees drop coverage first because the subsidy that made it affordable is gone, the remaining pool skews toward costlier claims, which is part of what is now pushing both pricing and participation decisions for the coming plan year.
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Which Insurers Are Leaving for 2027
As of the most recent KFF count, seven carriers have announced they will exit ACA marketplaces in some or all of their states for the 2027 plan year, while five carriers have announced plans to enter new state markets. Cigna is among the largest departures, having decided to leave the individual marketplace entirely across the eleven states where it currently sells both on- and off-exchange plans, citing limited room to grow that line of business.
Fewer Choices in a Growing Number of Counties
The average number of insurers offering marketplace plans per state fell from 9.6 in 2025 to 9.0 in 2026, and the number of counties with only a single participating insurer rose to 165, up from 93 the year before. Fewer competing insurers in a county typically means less competitive pricing, on top of the premium increases already flowing from the lapsed subsidy.
A county moving from several competing marketplace plans to just one does not necessarily mean coverage disappears; federal law still requires at least one plan be offered in every marketplace county. It does mean the price comparison that used to discipline premiums in that market is largely gone for 2027, leaving enrollees with less leverage to shop for a better rate.
Where Marketplace Coverage Meets Medicare Eligibility
The exits concentrate real consequences on marketplace enrollees who are not yet 65, since Medicare eligibility remains the eventual off-ramp from this market entirely. Someone in their early sixties renewing a marketplace plan this fall may find their current insurer gone from the exchange, their premium higher without the expired credit, or both, years before Medicare enrollment becomes an option.
For that age group, the marketplace exits arrive at an awkward moment: too young for Medicare, but old enough that switching plans, and possibly switching doctors if a new insurer’s network differs, carries more weight than it might for a younger enrollee with fewer ongoing prescriptions or specialist relationships.
What Comes Next in the KFF Tracker
KFF continues to update its 2027 participation tracker as state insurance departments finalize rate filings and additional carriers confirm exit or entry decisions, meaning the current tally of seven exits and five entries is a snapshot rather than a final count for the year ahead. Enrollees can still shop and compare available 2027 plans directly through HealthCare.gov or their state’s own marketplace exchange once open enrollment begins, regardless of how many insurers remain in a given county.
Comparing Marketplace Premiums to Medicare’s Fixed Costs
None of the marketplace turmoil above touches the separate cost questions that arrive the moment someone actually enrolls in Medicare, and those questions come with their own paperwork and their own deadlines that a lapsed subsidy notice will not explain.
The Medicare Cost & Coverage Protection Kit is a 10-page kit built around 51 state Medicare cost-help packs and the new Part D out-of-pocket cap.
Look up state cost-help contacts in The Medicare Cost & Coverage Protection Kit.
This article was reported and written with the help of AI tools and reviewed by The Financial Wire editorial team.
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.
