Insurers Pull Out of ACA Marketplaces Ahead of 2027

Nashville, Tennessee — Courtney Mroch already pays $1,250 a month for a silver-tier Affordable Care Act plan, up from $850 a month in 2025, according to NBC News. Now the 56-year-old, who has diabetes, asthma and a history of cancer, faces a different problem: her insurer, Cigna, is withdrawing from Tennessee's ACA marketplace altogether.

"Who knows who will cover me in 2027 or how much more it'll cost," Mroch said, according to NBC News.

Her situation illustrates a pattern taking shape across the country as ACA open enrollment begins Sunday in most states. Eleven insurers have told regulators they plan to leave at least some state marketplaces in 2027, according to an analysis by KFF, a nonpartisan health policy research organization, cited by NBC News. Six insurers have announced plans to enter new markets over the same period, leaving a net reduction in competition in many states.

Why Are Insurers Leaving ACA Marketplaces in 2027?

Cigna is exiting all 11 states where it currently sells ACA plans, a market that includes more than 350,000 enrollees, according to the KFF analysis reported by NBC News. The company's departure is the largest single withdrawal among the 11 insurers pulling back next year, though NBC News did not report the specific reasons Cigna or other insurers gave regulators for leaving.

"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, according to NBC News.

How Much Will ACA Premiums Rise in 2027?

Insurers that remain in the marketplace are proposing an average premium increase of about 15% for 2027, according to the KFF analysis of public filings across all 50 states and Washington, D.C., reported by NBC News. That would mark the second consecutive year of double-digit increases.

For Mroch, the math is already strained. Her family's monthly ACA premium now exceeds their mortgage payment, she told NBC News, and her husband has moved to a separate, non-ACA plan to hold down household costs.

Which States and Enrollees Are Most Affected?

NBC News did not publish a full state-by-state breakdown of which markets are losing insurers beyond Tennessee, where Cigna is withdrawing, and the 11 states where Cigna currently operates. The article did not name the other 10 insurers exiting marketplaces or specify which states they are leaving.

"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.

Yaver, quoted by NBC News, said the narrowing of insurer options could force people to switch doctors mid-treatment. "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," she said.

What Does This Mean for Patients With Chronic Conditions?

For enrollees managing ongoing illness, an insurer's exit can mean more than a premium increase. It can mean losing in-network access to a specialist or pharmacy mid-treatment, according to Yaver's comments to NBC News. Mroch's case — diabetes, asthma and cancer survivorship — places her among the enrollees most exposed to that kind of disruption, since switching plans often means confirming anew which providers and medications are covered.

Yaver also raised a related concern to NBC News: that even where options remain, the price points available may not work for every household budget, leaving some enrollees to choose between a costlier plan that fits their health needs and a cheaper one that may not.

What Happens Next During Open Enrollment?

Open enrollment runs for roughly two months in most states starting this weekend, according to NBC News, giving people who buy their own coverage a window to compare plans before insurer rosters shift again in 2027. For now, the immediate task for enrollees like Mroch is narrower: confirming which insurers will still be selling in their state for the coming year, and at what price, before current plans lapse.

KFF's analysis, as described by NBC News, frames 2027 as a turning point less because of a single large insurer's exit than because of the net direction — more companies leaving than entering a market that millions of Americans rely on to buy coverage outside an employer.

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