Courtney Mroch was already paying a high price for her health insurance when she learned that her insurer, Cigna, was withdrawing from Tennessee’s Affordable Care Act market.
The 56-year-old Nashville resident has diabetes and asthma and is a cancer survivor. This year, she pays $1,250 per month for a Silver plan, up from $850 per month in 2025, more than her family’s mortgage. To keep costs down, her husband is enrolled in a separate, less expensive, non-ACA plan.
“Who knows who will cover me in 2027 or how much more it will cost,” Mroch said.
Many Americans are moving toward open enrollment in the ACA with the likelihood of higher premiums and fewer insurance companies 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 next year.
Insurers that offer ACA plans are proposing premium increases of about 15% on average for 2027 — the second straight year of double-digit increases, according to an analysis by KFF, a nonpartisan health policy research group, that examined public records from insurers in all 50 states and Washington, D.C..
At the same time, 11 insurers have announced plans to exit the ACA markets in 2027 in at least some states where they currently offer coverage, according to KFF. Among them is Cigna, which will exit the 11 states where it offers ACA plans and has more than 350,000 ACA enrollees. Six insurers have announced their intention to enter new markets.
“The main takeaway is that more insurance companies are leaving the market than entering,” said Cynthia Cox, program director on the ACA at KFF.
For people looking for coverage, that could mean fewer insurers to choose from and more people having to switch plans.
“It’s going to create a lot of discontinuities in patient care and coverage,” 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 reduced number of options available to you, it can be very disruptive, especially if you have a chronic illness.”
“And if the reduced number of pricing tiers available doesn’t work for you, will you stay covered? » she added.
Why are insurers leaving?
The departures come after enhanced tax credits expire at the end of 2025, causing ACA enrollment to decline by about 3 million.
Some healthier people have opted for cheaper but worse coverage or dropped their insurance altogether. Those who stayed on their plan tended to have greater health needs and higher medical costs.
Overall, that can make the market less profitable for insurers as health care costs rise, said Jennifer Chumbley Hogue, an insurance broker in Texas.
From a consumer perspective, that means “constant upheaval, whether it’s plan withdrawal, changed subsidies or doctor network,” Hogue said.
In an email, a Cigna spokesperson highlighted April comments from CEO Brian Evanko, who said exiting the ACA market aligned with goals to position the company’s “core healthcare businesses for sustainable growth.”
For some families, the increase in premiums alone had already forced some families to make 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 their retirement savings.
The O’Connors are also covered by Cigna. She plans to work with a broker to find another plan, but her husband also plans to be uninsured for about six weeks until he qualifies for Medicare.
“It’s worrying,” she said. “He is in good health, but anything can happen at any time.”
Mark Lathrop, who lives in Idaho and owns a winery just across the Washington state line, said he and his wife were also looking for new coverage after their insurer, PacificSource, decided to exit the ACA market.
The couple is already facing higher costs. They don’t qualify for standard ACA subsidies, and Lathrop said a comparable plan for 2027 would cost about $17,600, up from about $16,000 last year. He requires 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 yet what we’re going to do,” he said.
In a statement, a PacificSource spokesperson said the decision to exit the ACA market was not “taken lightly” and was made to ensure it could “continue to fulfill our mission and serve our members for the long term amid increasing pressures in the healthcare industry.”
Yaver said the changes could undermine public support for the ACA. As fewer people sign up and those who remain face higher costs and fewer options, the market could become less attractive to consumers — thereby weakening the law without the Trump administration and Republicans ever having to repeal it.
A recent KFF poll found that overall public favorability for the ACA fell from 64% to 58%. “We are not planning to repeal or replace 2017, but we are making it much more difficult for patients to continue to benefit from these plans,” Yaver said.
Hogue urged registrants to review their options when open enrollment begins, rather than relying solely on the notices they receive in the mail. The bonuses and subsidies available to them, she explained, could be different from the amounts indicated in these letters.
“It’s worth taking five minutes to take a look,” she said.
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