ACA Insurers Exit Market as 2027 Premiums Surge 15%

Key points

• KFF analysis shows average 2027 ACA premium increases of 15%, following double-digit hikes in 2026.
• 11 insurers, including Cigna and PacificSource, are exiting marketplaces in 2027; Cigna is leaving 11 states with over 350,000 enrollees.
• The expiration of enhanced tax credits at the end of 2025 led to a 3 million drop in ACA enrollment, leaving a sicker, higher-cost risk pool.
• Open enrollment begins Sunday in most states, with a December 15 deadline for coverage starting January 1, 2027.
• Consumers above 400% of the federal poverty level face a subsidy cliff, losing all federal assistance if income exceeds the threshold.

Background

This development follows the Trump administration's removal of 750,000 enrollees for suspected fraud in September 2026 and the expiration of enhanced premium tax credits in late 2025. While Medicare Advantage premiums are projected to drop 16% for 2027, ACA marketplace costs are rising sharply due to reduced subsidies and insurer exits.

How outlets are covering it

NBC News and The Washington Post emphasize the crisis of insurers fleeing the market, citing Cigna's exit from 11 states and PacificSource's departure. KFF data highlights the 15% average premium increase and the imbalance of 11 insurers leaving versus 6 entering. The Tennessean provides state-specific details, noting rate hikes ranging from 4% to 40% and CMS efforts to reassign Cigna customers to prevent coverage lapses. Yahoo Finance focuses on the subsidy cliff for high-income earners, warning that those above 400% of the federal poverty level may face annual premiums exceeding $20,000 without assistance. Experts like Miranda Yaver warn of care discontinuities, while Jason Levitis notes that healthier individuals are more likely to drop coverage, worsening the risk pool.

Why it matters

The combination of rising premiums and insurer exits threatens to destabilize the ACA marketplace, potentially undermining public support and leaving millions without affordable coverage. As fewer insurers compete, consumers face limited options and higher costs, particularly those with chronic conditions or incomes above subsidy thresholds. This could lead to a cycle of reduced enrollment and further rate increases, weakening the law without formal repeal.

What to watch

Open enrollment begins Sunday, with a December 15 deadline for most states. Consumers should review plan options and subsidy eligibility, as mail notices may not reflect final costs. CMS is reassigning Cigna customers to other insurers to prevent coverage gaps. Democrats may push to restore expired subsidies if they regain control of Congress, while the Trump administration continues to enforce fraud crackdowns that may further reduce enrollment.