The expiration of enhanced subsidies at the end of 2025 altered the marketplace. In 2026, enrollment dropped, and the remaining risk pool became older and sicker.
Over the summer, a Peterson-KFF Health System Tracker analysis found that insurers had requested a 15% median premium bump for 2027, marking a second consecutive year of double-digit increases. States have been finalizing these rates, sometimes pushing back against insurers’ asks.
The eventual expiration also factored into 2026 pricing during last year’s open enrollment period, and the midterm election has the potential to resurface the issue.
Fast forward to today: The ACA open enrollment period is coming up Nov. 1. Payers have been evaluating their 2027 reach and are taking several different approaches.
A handful of payers are broadening their footprint. Oscar Health is expanding into South Carolina and increasing its county count by 24% from last year. AmeriHealth Caritas is bringing marketplace plans to Indiana and Ohio, as well. Kaiser Permanente is entering Nevada through its partnership with Reno, Nev.-based Renown Health, and Kaiser is not withdrawing from any states or counties, a spokesperson told Becker’s.
Antidote Health, Aspirus Health Plan, Peak Health, CalOptima Health and Colorado Access are also entering new ACA markets.
But growth is not the full picture. Insurers may be expanding in some areas while contracting in others.
For example, Centene’s Ambetter Health is expanding into 55 more counties. The insurer currently has more than 3.5 million members across 27 states and more than 1,700 counties. At the same time, Centene is discontinuing exchange coverage in Delaware and New Hampshire.
While UnitedHealthcare is exiting Georgia’s marketplace at the end of 2026, individual exchange plans will be available in 29 states. UnitedHealthcare is expanding service areas in five of those: Arizona, Florida, Indiana, Kansas and Michigan.
The Georgia exit followed UnitedHealthcare’s request for “a rather significant rate increase,” Garrison Bennett, the press secretary for Georgia’s Office of the Commissioner of Insurance and Safety Fire, previously told Becker’s. KFF reported that the insurer proposed a 54% increase for 2027. The state pushed back, and the insurer ultimately decided to leave.
Other insurers are holding steady. GuideWell, the parent company of Florida Blue, told Becker’s that Florida Blue is still selling ACA plans in all 67 of the state’s counties. Another subsidiary, Florida Health Care Plans, will sell ACA plans within its footprint of five counties. Health Care Service Corp. is also sticking with its current footprint, serving members across five states in 2027, the company confirmed.
UnitedHealthcare and Centene are not alone in announcing exits. Molina Healthcare is cutting more than half of its marketplace states, paring down to six. Medica is also slimming its footprint, exiting three states.
Some insurers are pivoting away from the ACA entirely. Cigna’s rollback of exchange coverage will affect about 369,000 members across several states. Baylor Scott & White Health Plan, Mending, ConnectiCare, PacificSource and Providence Health Plan are also abandoning their exchange businesses.
For some, exits are part of broader pivots away from insurance: Mending is upending its business model, and Providence Health Plan is shuttering entirely. For others, the departures signal more uncertainty about the sustainability of ACA businesses in particular as policies and enrollment shift.
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