Courtney Mroch was already paying top dollar for health insurance when she learned her insurance company, Cigna, was withdrawing from Tennessee’s Affordable Care Act marketplace.
The 56-year-old Nashville resident has diabetes and asthma and is a cancer survivor. This year, she’s paying $1,250 a month for the silver plan, up from $850 a month in 2025 and more than her family’s mortgage. To reduce costs, her husband enrolled in a lower-cost stand-alone, non-ACA plan.
“Who knows who will insure me in 2027 or how much it will cost,” Moroch said.
Many Americans are entering ACA open enrollment, but premiums are likely to be higher and there are fewer insurance companies to choose from. In most states, the enrollment period begins Sunday, giving people buying their own insurance about two months to compare plans for next year.
An analysis of public filings by insurance companies in all 50 states and Washington, D.C., by KFF, a nonpartisan health policy research group, found that insurers offering ACA plans are recommending an average premium increase of about 15% in 2027, marking the second consecutive year of double-digit increases.
Meanwhile, 11 insurance companies have announced plans to exit the ACA market in 2027, at least in some states where they currently offer coverage, according to KFF. Among them is Cigna, which will withdraw from all 11 states that offer ACA plans and has more than 350,000 ACA enrollees. Six insurance companies have announced plans to enter new markets.
“The main takeaway is that more insurance companies are leaving the market than entering it,” said Cynthia Cox, KFF ACA program director.
For people buying insurance, this could mean fewer insurers to choose from and more people having to change plans.
“It’s going to create a lot of discontinuity in people’s care and coverage,” said Miranda Yaver, assistant professor of health policy and management at the University of Pittsburgh. “If your doctor doesn’t accept the fewer options available to you, that can be very disruptive, especially if you have a chronic condition.”
“If the fewer available price points don’t suit you, will you continue to buy?” she added.
Why are insurance companies withdrawing?
These departures come after the enhanced tax credit expires at the end of 2025, resulting in a drop in ACA enrollment of about 3 million students.
Some healthy people switch to cheaper but worse insurance, or drop coverage altogether. Those who remain on the plan tend to have greater health needs and higher medical costs.
Jennifer Chumbley Hogue, a Texas insurance broker, said overall, as health care costs rise, insurance companies are likely to see lower market profits.
From a consumer perspective, Hogg said, this means “constant upheaval, whether it’s plans exiting, subsidy changes, or physician network changes.”
In an email, a Cigna spokesman pointed to comments in April from Chief Executive Brian Evanko, who said leaving the ACA market was consistent with the goal of positioning the company’s “core health care business for sustainable growth.”
For some families, rising premiums alone are forcing them to make tough financial decisions.
Denise O’Connor and her husband’s monthly premiums in Colorado more than doubled this year, from more than $900 to about $2,300, forcing them to dip into their retirement savings.
The O’Connors were also protected by Cigna. She plans to work with an agent to find another plan, but her husband is also considering going without insurance for about six weeks until he qualifies for Medicare.
“It’s a concern,” she said. “He’s healthy but anything can happen at any time.”
Mark Lathrop, who lives in Idaho and owns a brewery across the state line in Washington, said he and his wife are also looking for new coverage after insurance company PacificSource decided to withdraw from the ACA market.
The couple is already facing higher costs. They are not eligible for standard ACA subsidies, and Lathrop said a similar plan in 2027 would cost about $17,600, up from about $16,000 last year. He needs an annual MRI to monitor his spinal cord injury, which costs $2,400, so a plan with a lower deductible is important. “We don’t know what to do yet,” he said.
A spokesperson for PacificSource said in a statement that the decision to exit the ACA marketplace was not “made lightly” but was made to ensure it can “continue to deliver on our mission and serve our members over the long term at a time when the entire health care industry is facing increasing pressure.”
Yaffe said the changes could erode support for the Affordable Care Act. As fewer people join and those who stay face higher costs and fewer options, the market could become less attractive to consumers — weakening the law without the Trump administration and Republicans having to repeal it.
A recent KFF poll found that the public’s overall favorability rating for the ACA dropped from 64% to 58%. “We’re not going to see the 2017 plans repealed and replaced, but we’re making it harder for patients to stay on those plans,” Yaver said.
Hogg urged registrants to review their options when open enrollment opens rather than rely solely on notifications they receive in the mail. The premiums and subsidies they can receive may differ from the amounts listed in those letters, she said.
“It’s worth taking five minutes to look,” she said.