11 Insurers Exit ACA Marketplaces in 2027, Led by 350,000 Cigna Members
Every October, hundreds of thousands of Americans open an envelope from their health insurance company and learn that their plan won't exist on Jan 1.
For 2027, KFF tracks 11 insurance carriers that have announced they are exiting Affordable Care Act Marketplaces in some or all of their states, while only 6 carriers are entering new state marketplaces.
The biggest exit comes from Cigna. After reporting more than 350,000 on-exchange enrollees in the first quarter, Cigna decided to leave the individual market completely for 2027, pulling out of all 11 states where it currently sells plans, both on and off the exchange, to focus on other lines of business. Centene's Ambetter, the largest Marketplace insurer in the country with 3.5 million members across 27 states, is also exiting Delaware and New Hampshire for 2027.
KFF's analysts explain the business calculation plainly. After enhanced federal premium subsidies expired and Marketplace sign-ups fell by more than 1 million people between 2025 and 2026, insurers re-evaluated which states were still profitable enough to stay in. Where the risk pool shrank or tilted toward sicker patients, carriers packed up.
From an insurance executive's desk, exiting 2 states or 11 states is portfolio management.
From a patient's kitchen table, it means starting over.
When your carrier leaves the state, you don't just pick a new logo and a new monthly premium by Dec 31. You inherit a new provider directory, a new prescription formulary, a new prior-authorization department, and a very real chance that the family doctor you have seen for 6 years isn't in the new network.
Oddly enough, even the carriers staying in the market have noticed that patients are exhausted by the friction. For 2027, Centene is marketing condition-specific plans in North Carolina and Ohio with four $0 cardiologist visits a year, and Oscar Health is launching a "RetireEase" plan in 5 states promising set prices for labs and routine services. Insurers are now using $0 visits and posted prices as a headline sales pitch, as long as they haven't pulled out of your county.
Direct primary care gives you that simplicity without tying it to an insurance carrier's annual earnings call.
When you pay your primary care physician a direct monthly membership, your doctor doesn't belong to Cigna, Ambetter, or Oscar. If your insurer exits your state this fall and you have to move your catastrophic coverage to a new carrier on Nov 1, your doctor stays put. Your medical chart stays put. The cell phone number you text when your kid wakes up with a fever stays put.
Insurance companies enter and exit markets every year. Your relationship with your physician shouldn't be on a 12-month lease.
Get the newsletter: directcare.org/newsletter