ACA insurers seek 15% premium hikes as 11 firms exit markets

Courtney Mroch, a 56-year-old resident of Nashville, Tennessee, pays $1,250 a month for a silver-level health plan. That amount is significantly higher than the $850 she paid in 2025. Her family mortgage costs less than her current medical insurance premium. Mroch has diabetes, asthma, and survived cancer. To manage expenses, her husband is enrolled in a separate, lower-cost plan outside the Affordable Care Act marketplace.

Mroch is one of many Americans facing higher costs and fewer choices during the open enrollment period. In most states, enrollment begins on Sunday. Shoppers have approximately two months to select coverage for the coming year. The market is shifting as insurers adjust to changes in the pool of enrollees.

Insurers are proposing average premium increases of about 15% for 2027. This marks the second consecutive year of double-digit price hikes. A review by the Kaiser Family Foundation, a nonpartisan health policy research group, analyzed public documents from insurers in all 50 states and the District of Columbia. The group found that 11 insurance companies plan to leave ACA markets in at least some states where they currently operate in 2027.

Cigna is among the companies exiting. The firm will withdraw from all 11 states where it offers ACA plans. It currently serves more than 350,000 enrollees through the marketplace. Only six insurers have announced plans to enter new markets. Cynthia Cox, director of the ACA program at KFF, stated that more companies are leaving the market than entering it.

The exodus follows the expiration of expanded tax credits at the end of 2025. ACA enrollment fell by approximately 3 million people after the credits ended. Healthier individuals often switched to cheaper, lower-benefit plans or dropped coverage entirely. The remaining enrollees tend to have higher health needs and greater medical costs. Jennifer Chumbley Hogue, a Texas insurance broker, said this dynamic makes the market less profitable for insurers as medical costs rise.

Miranda Yaver, an associate professor of health policy and management at the University of Pittsburgh, warned of potential disruptions in care. She noted that if a patient’s doctor is not in the network of the few remaining options, it could be disruptive, especially for those with chronic conditions. She asked whether people will maintain coverage if the available prices do not work for them.

A Cigna spokesperson cited April comments from CEO Brian Evanko. He said leaving the ACA market aligns with goals to position the company’s core health businesses for sustainable growth. In Colorado, Denise O’Connor and her husband saw their monthly premiums more than double this year. Their costs rose from just over $900 to about $2,300. They used retirement savings to cover the difference. Her husband is considering going without insurance for six weeks until he qualifies for Medicare.

Mark Lathrop, who lives in Idaho near the Washington state border, is also seeking new coverage. His insurer, PacificSource, decided to leave the ACA market. The couple does not qualify for standard subsidies. Lathrop said a comparable 2027 plan would cost around $17,600, up from about $16,000 last year. He requires an annual MRI to monitor a spinal cord injury, which costs $2,400. He needs a plan with a lower deductible. A PacificSource spokesperson said the decision was not taken lightly and was made to ensure the company can serve enrollees long-term.

Yaver said these changes could weaken public support for the ACA. A recent KFF poll found that overall favorable ratings for the law dropped to 58% from 64%. She described the process as making it harder for patients to stay in plans without formally repealing the law. Hogue advised enrollees to review their options when open enrollment starts, rather than relying solely on mailed notices. She noted that premiums and available subsidies may differ from the amounts listed in those letters.