Six health insurers have confirmed they are leaving the Affordable Care Act marketplace for the 2027 plan year, a wave that will force roughly 650,000 enrollees across a third of the states to pick a new carrier before this winter’s open enrollment closes. Cigna Health, CareSource, PacificSource, Baylor Scott and White, Providence Health and the startup Mending are walking away from state exchanges after two straight years of premium spikes tied to the expiration of enhanced federal subsidies. The retreat concentrates coverage decisions in fewer companies and leaves some counties with only one marketplace insurer left standing.
Cigna’s Exit Alone Displaces 369,000 Enrollees Across Eleven States
Cigna’s departure is the single largest domino in the 2027 shakeup. The insurer will exit all 11 states where it currently sells marketplace plans — Arizona, Colorado, Florida, Georgia, Illinois, Indiana, Mississippi, North Carolina, Tennessee, Texas and Virginia — displacing about 369,000 enrollees. Cigna’s incoming chief executive, Brian Evanko, told analysts in late April that the company saw no viable path to grow an on-exchange business that had already shrunk 17% from a year earlier, a business KFF’s own tracking put at just over 350,000 members based on Cigna’s first-quarter investor filing.
CareSource and Baylor Scott and White are retreating for a different reason. CareSource, a nonprofit built around Medicaid managed care, is dropping marketplace plans in Indiana, Ohio and West Virginia, where it covers close to 90,000 people. In Texas, Baylor Scott and White Health Plan is leaving both the marketplace and Medicaid entirely, stranding roughly 100,000 enrollees. Unlike Cigna’s single strategic pullback from an underperforming national product line, both are hospital-system-affiliated plans exiting because an individual market with a shrinking, sicker risk pool no longer supports the provider networks built around it.
Combined, those three insurers alone account for more than 550,000 of the roughly 650,000 people who will need new coverage, a figure Georgetown University’s Center on Health Insurance Reforms attributed to healthinsurance.org’s tally of the six confirmed 2027 exits. The remaining displacement is split between Providence, PacificSource and Mending, whose enrollee bases are smaller but concentrated in states where marketplace competition was already thin before 2027.
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Oregon’s Marketplace Narrows to Four Carriers as Regional Insurers Retreat
Oregon shows what a thinning marketplace looks like at the state level. PacificSource and Providence Health, which together cover nearly 96,000 enrollees across Oregon, Idaho and Montana, are both leaving after concluding they lack the scale to negotiate hospital rates the way national insurers can. Providence chief executive Erik Wexler said larger carriers have consolidated enough to operate more efficiently, leaving regional nonprofit plans like his in what he called an “untenable situation.” The exits will cut Oregon’s marketplace from six insurers to four, though the state’s insurance commissioner has said every county will still keep at least three plan options.
KFF’s most recent county-level analysis found 165 counties nationwide had only one marketplace insurer left in 2026, up from 93 counties the year before, a jump driven mainly by Aetna’s exit from 17 states. With PacificSource, Providence, CareSource and the others leaving for 2027, that single-insurer count is expected to climb again once KFF updates its analysis after this fall’s plan filings are finalized.
Five new carriers, including Colorado Access, are entering select state marketplaces for 2027, but none is large enough to replace the multistate provider networks the departing insurers spent a decade building. A single-state entrant negotiating hospital contracts from scratch starts with none of the leverage that let Cigna or Providence hold prices down in the markets they are now abandoning.
Two Federal Policy Shifts Are Squeezing Insurers From Both Directions
Every insurer’s exit points back to the same trigger. Enhanced premium tax credits that had subsidized marketplace premiums since 2021 expired at the end of 2025, and KFF’s tracking shows that change contributed to marketplace sign-ups falling by more than a million between the 2025 and 2026 open enrollment periods. KFF projects effectuated enrollment could decline by roughly five million people over the course of 2026 as healthier enrollees drop coverage rather than pay the higher net premium. That leaves insurers covering a smaller, sicker pool of policyholders, raising the average cost of every claim and eroding the margin calculations that determined which states carriers were still willing to serve.
Two additional federal actions compounded the subsidy cliff. Congress’s 2025 reconciliation law tightened the documentation required to claim marketplace tax credits, and the Centers for Medicare and Medicaid Services finalized a 2027 marketplace rule in May that raises out-of-pocket costs and adds enrollment paperwork the agency itself projects will push another 1.2 million to 2 million people off exchange coverage. Insurers cited both changes directly in their 2027 rate filings as reasons to expect a smaller, costlier risk pool going forward, and for at least six carriers, the resulting calculation was to leave rather than raise prices again and hope enrollment held.
For enrollees whose plans are being discontinued, coverage does not lapse midyear — current plans stay active through December 31 as long as premiums are paid. The disruption arrives at open enrollment, when anyone who does not actively select a new plan is auto-mapped by the marketplace to a similarly priced option from a remaining carrier. That default assignment preserves a comparable premium and metal tier, but it does not preserve a provider network: a household defaulted out of Cigna, PacificSource or Baylor Scott and White can still lose an existing doctor or specialist regardless of which plan tier the marketplace assigns.
Whether the carriers who remain use their reduced competition to hold prices steady or push them higher heading into 2028 is the question state insurance regulators say they are watching most closely as this year’s rate filings work through review. With hospital-system plans and regional nonprofits exiting in favor of a smaller set of national insurers, the leverage in that negotiation has already shifted before a single 2027 premium has been finalized.
This article was researched and drafted with the assistance of artificial intelligence.
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