As of June 8, 2026, six carriers have announced that they will exit the ACA Marketplaces in plan year 2027, either in some or all states that they are currently offering plans: Cigna Health, CareSource, PacificSource, Scott and White, Providence Health, and Taro Health. These insurer exits, expected to impact roughly a third of states, follow the expiration of the enhanced premium tax credits at the end of 2025, which drove sign-ups to fall by over a million from the 2025 to 2026 Open Enrollment Periods—with further membership declines in the ACA Marketplaces expected as the year progresses. ACA Marketplace enrollment declines affect the size of the potential market for insurers, and, potentially, the risk pool—to the extent that healthier than average enrollees are more likely to drop coverage.
As people leave the Marketplace, insurers may reassess the profitability of their Marketplace participation and decide to pull out in the future. Cigna has decided to leave the individual market in 2027 to focus on other segments given the lack of potential to grow their ACA Marketplace business. Cigna, which reported first-quarter on-exchange enrollment of over 350,000 individuals, will exit the 11 states in which it currently participates both on- and off-exchange. In some cases, multiple insurers are announcing exits in the same state, such as in Indiana, Oregon, and Texas. With fewer insurers participating in the ACA Marketplaces, remaining insurers will have less competition and consumers will be left with fewer choices. For example, after the departure of CareSource and Cigna from Indiana, only three companies will remain in that state’s Marketplace if no other companies enter.
In 2025, an average of 9.6 insurers per state participated in the ACA Marketplaces, but this number has since declined to 9.0 insurers in 2026, driven primarily by the exit of Aetna CVS from the Marketplaces. It is possible that more insurers will announce exits ahead of the 2027 plan year and average insurer participation in the ACA Marketplaces will continue to decline. Despite the number of insurers that have decided to exit the ACA Marketplaces for plan year 2027, at least one insurer (Colorado Access Group) has indicated that it is entering the market.
While insurer participation in the ACA Marketplaces is not yet fully in focus, there are no signs at this point that there will be “bare” counties with no insurers at all, which was a major concern during an earlier period of instability.
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