ACA insurers exit markets

Courtney Mroch, 56, pays $1,250 a month for her health insurance in Nashville. That is more than her family’s mortgage. The cost jumped from $850 in 2025 to its current level. She lives with diabetes, asthma, and a history of cancer. Her insurer, Cigna, announced it is leaving the Tennessee market entirely. Mroch now faces a choice between fewer options or higher costs for 2027. Her husband enrolled in a separate, cheaper plan outside the ACA to help manage expenses. “Quién sabe quién me cubrirá en 2027 o cuánto más costará,” Mroch said.

The situation reflects a wider trend. Open enrollment for the Affordable Care Act begins Sunday in most states. Consumers have about two months to compare plans for the coming year. KFF, a nonpartisan health policy research group, analyzed public filings from insurers in all 50 states and Washington, D.C. The group found that insurers are proposing an average premium increase of 15% for 2027. This marks the second consecutive year of double-digit hikes. At the same time, 11 insurance companies announced plans to exit at least some ACA markets in 2027. Six other companies plan to enter new markets. Cynthia Cox, director of the KFF program on the ACA, noted that more insurers are leaving than entering. “La principal conclusión es que más compañías de seguros están saliendo del mercado que entrando,” Cox said.

The departures follow the expiration of extended tax credits at the end of 2025. Enrollment in ACA plans dropped by approximately three million people after that change. Healthier individuals often switched to cheaper plans or dropped coverage altogether. Those who remained tend to have higher medical needs. Jennifer Chumbley Hogue, an insurance broker in Texas, explained that this shift makes the market less profitable for insurers as medical costs rise. Consumers face what Hogue described as “agitación constante” due to plan withdrawals, subsidy changes, or shrinking provider networks.

Cigna’s exit from 11 states affects more than 350,000 members. A Cigna spokesperson cited comments from CEO Brian Evanko in April. He stated that leaving the ACA market aligns with the company’s goal of positioning its core health businesses for sustainable growth. Other families face similar financial pressures. Denise O’Connor and her husband in Colorado saw their monthly premiums more than double, rising from just over $900 to about $2,300. They had to draw on retirement savings. O’Connor is working with a broker to find a new plan. Her husband is considering going without insurance for six weeks until he qualifies for Medicare. “Es una preocupación,” she said, noting that he is healthy but anything can happen.

Mark Lathrop in Idaho is also seeking new coverage after PacificSource decided to leave the ACA market. He and his wife do not qualify for standard ACA subsidies. A comparable plan for 2027 would cost around $17,600, up from about $16,000 last year. Lathrop needs an annual MRI to monitor a spinal cord injury. The procedure costs $2,400, making a lower deductible essential. “Todavía no sabemos qué vamos a hacer,” Lathrop said. A PacificSource spokesperson said the decision was not made “a la ligera” and was intended to ensure the company can continue serving members long term amid sector-wide pressures.

Miranda Yaver, an associate professor of health policy and management at the University of Pittsburgh, warned that these changes could disrupt care. “Esto va a crear muchas discontinuidades en la atención y la cobertura para la gente,” Yaver said. If patients’ doctors are not in the remaining networks, continuity of care suffers, especially for those with chronic conditions. Yaver noted that the market may weaken without formal repeal. A recent KFF survey found favorable ratings for the ACA fell from 64% to 58%. “No vemos la ‘derogación y reemplazo’ de 2017, pero estamos haciendo mucho más difícil que los pacientes se mantengan en estos planes,” Yaver said.

Hogue advises consumers to review their options during open enrollment rather than relying solely on mailed notices. 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.