All the insurers exiting ACA Obamacare exchanges for 2027
Fri, August 28, 2026 at 8:19 PM GMT+3 4 min read
About a million Americans had to find new health insurance at the start of 2026. CVS Health's Aetna subsidiary pulled out of the Affordable Care Act marketplace in 17 states, and at least a dozen more carriers announced they'll stop selling plans next year. When that happens, several hundred thousand more people will need to find coverage elsewhere.
The departures aren't random. When enhanced federal subsidies expired at the end of 2025, premiums jumped, and healthier enrollees dropped coverage. Insurers found themselves covering a smaller, sicker group, and one by one, they decided to stop. The numbers were no longer adding up.
Texas has lost three carriers in two years. Oregon is down another two. For the millions of people who depend on marketplace coverage, every exit gives the insurers who stay less reason to keep prices low.
Every confirmed insurer departure from the marketplace
CVS Health was the first major provider to leave. Its Aetna marketplace enrollees were running up medical bills that exceeded what the company collected in premiums, and CVS projected losses of up to $400 million on its ACA plans in 2025. It was the company's second retreat from the exchanges: Aetna had pulled out in 2017, returned in 2022, expanded into more states in 2023, and still couldn't make the business work.
Cigna followed in late April. The insurer's marketplace enrollment had already fallen 17% from a year earlier, and its president and incoming CEO, Brian Evanko, told analysts there was no viable path to growth. Cigna will leave all 11 states where it sells plans, displacing about 369,000 enrollees, according to healthinsurance.org and Becker's Payer Issues.
Oregon shows what happens when a state loses carriers it can't replace. PacificSource and Providence, which together cover nearly 96,000 enrollees across Oregon and neighboring states, are both leaving the area after confronting an impossible gap. Neither has enough enrollees to negotiate the rates with hospitals that national carriers can, leaving them in an "untenable situation," Providence CEO Erik Wexler said. Oregon will drop from six marketplace insurers to four, and no new carrier is entering for 2027.
Texas faces a similar contraction. Baylor Scott & White, a health system that also runs marketplace plans, will leave both the marketplace and Medicaid, according to healthinsurance.org. Roughly 100,000 enrollees will have to switch carriers. Others are choosing which states to keep and which to abandon. Molina Healthcare will cut more than half its presence, dropping from 14 states to six. CareSource will leave Indiana, Ohio, and West Virginia, where it covers nearly 90,000 enrollees. Centene will reshuffle its brands in Delaware, New Hampshire, and Florida, moving affected members between subsidiaries.
Mending, formerly Taro Health, will leave the insurance business entirely. The startup will shut down its operations and pivot to direct primary care, leaving about 8,100 enrollees in Maine and Oklahoma without a carrier. Medica, ConnectiCare, and Cox will also pull back from Iowa, Kansas, Oklahoma, Connecticut, and Missouri, according to KFF.
Financial and regulatory pressure on marketplace carriers
Even with net premiums jumping 58%, carriers still in the market can't make the economics work. Cigna's president and incoming CEO, Brian Evanko, told analysts in late April that there was no viable way to grow enrollment that had already shrunk 17% from a year earlier. Providence's Wexler said national insurers have consolidated enough to operate at a scale that regional, not-for-profit plans can't match. PacificSource said its claims costs had outpaced what it could charge in premiums.
Proposed 2027 premiums are heading for double-digit increases for the second consecutive year, according to Georgetown's Center on Health Insurance Reforms, because the enrollees who kept their coverage through 2026's price shock use more care and cost more to cover. Higher premiums will push out more of the enrollees insurers need to keep costs down, and drive average costs higher still.
Federal policy will shrink the market further. Congress tightened the rules for claiming premium tax credits through H.R. 1, the reconciliation bill it passed in 2025. CMS imposed new documentation requirements the same year for people enrolling outside open enrollment. And CMS's finalized 2027 rule will raise out-of-pocket costs and add more paperwork at sign-up, changes that could push another 1.2 million to 2 million people out of the market, according to Georgetown's center.
Enrollment losses and the 2027 outlook for affected states
The exits announced so far don't affect 2026 coverage. People on expiring plans can maintain access through Dec. 31 by paying their premiums. But they'll need to find a new insurer at the start of next year. Those who don't will be placed on the cheapest available plan at roughly the same coverage level.
The replacement plan assumes there are options. In 165 counties, only one insurer sells marketplace plans, according to KFF, up from 93 last year. In states where several carriers remain, the choices are narrowing. Each departing insurer takes its provider network with it, and for patients, losing a plan can mean losing a doctor, too.
Five new carriers plan to enter state marketplaces for 2027, but they won't replace what's leaving. The departing carriers negotiated hospital and pharmacy rates on the strength of enrollment that stretched across multiple states. Colorado Access, one of the new entrants, will sell in part of one state. It won't have the enrollment to demand the same rates.
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