ACA Enrollees Face Higher Costs and Fewer Choices as Insurers Exit Markets

Courtney Mroch was already paying a steep price for health insurance when she learned that Cigna was pulling out of Tennessee’s Affordable Care Act marketplace.

The 56-year-old Nashville resident has diabetes and asthma and is a cancer survivor. She pays $1,250 a month for a silver plan this year, up from $850 a month in 2025 — more than her family’s mortgage. To keep costs lower, her husband is enrolled in a separate, non-ACA plan that is less expensive.

“Who knows who will cover me in 2027 or how much more it’ll cost,” Mroch said.

Many Americans are entering ACA open enrollment with the prospect of higher premiums and fewer insurers to choose from. In most states, the enrollment period begins Sunday, giving people who buy their own coverage about two months to compare plans for the coming year.

Insurers offering ACA plans are proposing average premium increases of about 15% for 2027, according to a KFF analysis of public filings from insurers in all 50 states and Washington, D.C. That would mark the second consecutive year of double-digit increases.

At the same time, 11 insurers have said they plan to leave the ACA marketplaces in 2027 in at least some states where they now sell coverage, KFF found. Cigna is among them, and it will exit all 11 states where it currently offers ACA plans, affecting more than 350,000 enrollees. Six insurers have announced plans to enter new marketplaces.

“The main takeaway is that more insurance companies are leaving the marketplace than coming in,” said Cynthia Cox, director of the program on the ACA at KFF.

For consumers shopping for coverage, that could mean fewer choices and more plan changes.

“This is going to create a lot of discontinuities in care and coverage for people,” said Miranda Yaver, an assistant professor of health policy and management at the University of Pittsburgh. “If you have a doctor who doesn’t accept the fewer number of options that are available to you, that can be very disruptive, especially if you’re someone who has a chronic illness.”

“And if the fewer available price points don’t work for you, are you going to remain covered?” she added.

Why are insurers leaving?

The exits come after enhanced tax credits expired at the end of 2025, which drove ACA enrollment down by roughly 3 million.

Some healthier enrollees switched to cheaper but less comprehensive coverage or dropped insurance entirely. Those who stayed on their plans generally had greater health needs and higher medical costs.

That can make the marketplace less profitable for insurers as healthcare costs rise, said Jennifer Chumbley Hogue, an insurance broker in Texas.

For consumers, she said, it means “constant upheaval, whether it’s the plan pulling out or the subsidies have changed or the doctor network has changed.”

In an email, a Cigna spokesperson pointed to comments from CEO Brian Evanko, who said the company’s decision to leave the ACA marketplace fits its efforts to position its “core healthcare businesses for sustainable growth.”

For some families, rising premiums alone have already forced difficult financial decisions.

Denise O’Connor and her husband saw their monthly premiums in Colorado more than double this year, from just over $900 to about $2,300, forcing them to dip into retirement savings.

The O’Connors are also covered by Cigna. She plans to work with a broker to find another plan, but her husband is also considering going uninsured for about six weeks until he qualifies for Medicare.

“It’s a worry,” she said. “He’s healthy, but anything can happen at any time.”

Mark Lathrop, who lives in Idaho and owns a winery just across the state line in Washington, said he and his wife are also looking for new coverage after their insurer, PacificSource, decided to leave the ACA marketplace.

The couple is already facing higher costs. They do not qualify for standard ACA subsidies, and Lathrop said a comparable plan for 2027 would cost about $17,600, up from about $16,000 the previous year. He needs an annual MRI to monitor a spinal cord injury, which costs $2,400, making a plan with a lower deductible important.

“We don’t know what we are going to do yet,” he said.

In a statement, a PacificSource spokesperson said the decision to exit the ACA marketplace was not “made lightly” and was intended to ensure the company can “continue fulfilling our mission and serving members for the long term amid growing pressures across the healthcare industry.”

Yaver said the changes could weaken public support for the ACA. As fewer people enroll and those who remain face higher costs and fewer options, the marketplace could become less appealing to consumers — undercutting the law without repeal.

A recent KFF poll found public favorability toward the ACA fell to 58% from 64%. “We don’t see the repeal and replace of 2017, but we’re making it much harder for patients to remain on these plans,” Yaver said.

Hogue urged enrollees to review their options once open enrollment starts, rather than rely only on the notices they get in the mail. The premiums and subsidies available to them, she said, may differ from the amounts listed in those letters.

“It’s worth the five minutes to take a look,” she said.