Eleven health insurers will leave some or all of their ACA Marketplace states in 2027, and seven will enter new ones, according to a KFF tracker updated October 28, 2026. Cigna alone exits all 11 of its states. Patients in those plans must pick new coverage, so practices should expect insurance card changes and eligibility denials in January.
Which insurers are leaving the ACA Marketplace in 2027?
KFF lists 11 parent companies that will exit at least one state Marketplace for plan year 2027. The biggest is Cigna, which plans to leave the individual market in all 11 states where it sells plans today, both on and off the exchange. Cigna reported more than 350,000 people in its exchange plans in the first quarter of 2026.
Here are the announced exits by insurer group, as of October 28, 2026:
| Insurer group | States it plans to exit for 2027 |
|---|---|
| Cigna | AZ, CO, FL, GA, IL, IN, MS, NC, TN, TX, VA |
| Molina Healthcare | IL, KY, MS |
| CareSource | IN, OH, WV |
| Medica | IA, KS, OK |
| PacificSource | ID, MT, OR |
| Centene | DE, NH |
| Taro Health | ME, OK |
| UnitedHealth | GA |
| Cox | MO |
| Providence | OR |
| Scott and White | TX |
KFF says this list may still change. Check each insurer’s notice for your state before you act on it.
Which insurers are entering new Marketplace states?
Seven insurer groups plan to enter new states in 2027. KFF lists CalOptima Health in California, Colorado Access in Colorado, Antidote Health in Georgia and Texas, Independence Blue Cross in Indiana, Aspirus Health Plan in Minnesota, Oscar Health in South Carolina and Peak Health in West Virginia.
New entrants matter to your front desk. If you have no contract with a new plan, patients who move to it may show up out of network on January 2.
Why are so many insurers pulling out now?
Marketplace enrollment is shrinking. The enhanced premium tax credits ended on December 31, 2025. KFF reports that sign ups fell by more than a million from the 2025 to the 2026 open enrollment period, and it expects more drops during 2026.
A JAMA research letter published October 29, 2026 puts the national loss at 3 million enrollees from 2025 to 2026, a 13% decline. When fewer people buy plans, insurers rethink whether the market still pays. Cigna has said it will focus on other parts of its business.
What happens to patients whose Marketplace plan is leaving?
They get moved to a similar plan unless they choose one first. HealthCare.gov says that if a company offers no similar plan next year, it will enroll the person in a comparable plan, which may come from a different insurance company.
The key dates for 2027 coverage on HealthCare.gov are:
- November 1: open enrollment starts.
- December 15: last day to pick a plan that starts January 1.
- January 15: open enrollment ends. Coverage then starts February 1.
State run Marketplaces can set their own dates, so check your state site too.
For a practice, this means many patients will carry a new member ID, a new payer and maybe a new network on January 1. Some will not know it until a claim comes back.
How many patients are already uninsured or underinsured?
Nearly half of working age adults had coverage that fell short in 2026. The Commonwealth Fund’s 2026 Biennial Health Insurance Survey, released October 22, 2026, found that 46% of adults ages 19 to 64 were uninsured, had a gap in coverage or were underinsured.
The survey also found:
- The uninsured rate for working age adults rose from 8.9% in 2024 to 11.2% in 2026.
- Marketplace and individual market coverage fell from 8.5% to 6.4% over the same period.
- Half of people in Marketplace plans who had coverage all year were underinsured.
- 50% of working age adults went without needed care because of cost, up from 46% in 2022.
- Three in 10 working age adults were paying off medical debt.
- 19% of Marketplace enrollees said they moved to a plan with a lower premium and higher deductible and out of pocket costs.
The survey also notes that the maximum out of pocket limit for commercial plans climbs to $12,000 for an individual and $24,000 for a family in 2027.
How will these changes hit practice revenue?
Expect more eligibility denials, more patient balances and slower cash in the first quarter of 2027. Each of these traces back to a coverage change.
Eligibility denials come first. A patient who hands over an old Cigna card in January will get a claim denied for no active coverage. If your staff catch it at check in, you can bill the right plan. If they miss it, the claim bounces weeks later and the patient may be hard to reach.
Network problems come next. Patients moved to a new insurer may land in a plan you do not contract with. Out of network claims pay less, or not at all, under many Marketplace plans.
Patient balances grow last. Higher deductibles shift more of each visit onto the patient. The Commonwealth Fund data show many of these patients already struggle to pay. That means more aged balances and more write offs unless you collect at the visit.
Medicaid changes add to the load. The Commonwealth Fund notes that new Medicaid rules take effect in January, including work requirements of 80 hours a month for most expansion adults and eligibility checks every six months.
What this means for practices with 1 to 15 providers
Small practices feel coverage churn quickly because one person often handles both check in and billing. A short plan made in November protects January cash flow. Here are the steps to take now.
- Pull your Marketplace patient list. Run a report of active patients with an individual market plan from any exiting insurer in your state. Sort by next visit date.
- Tell those patients early. Send a short note or text before December 15 that says their plan is ending and asks them to bring their new card in January.
- Check your contracts against the new entrants. If a new insurer is coming to your state, ask whether you are in its network. If not, decide whether to apply for enrollment now.
- Verify every patient in January. Run an eligibility check for each visit in the first weeks of 2027, even for patients you saw in December.
- Update cards and IDs at check in. Scan the front and back of every new card and update the payer and member ID before the visit.
- Collect at the visit. Give patients a cost estimate before care and collect copays and known deductible amounts at check in.
- Offer payment plans with clear terms. Patients with medical debt are more likely to pay over time than in one bill.
- Watch your denial codes. Track eligibility and coverage denials weekly through March so you can fix a pattern fast.
Practices in Cigna states, including Texas, Florida, Georgia and Illinois, should start first. That single exit touches 11 states at once.
Frequently asked questions
Is Cigna leaving the ACA Marketplace in 2027?
Yes. KFF reports that Cigna will exit the individual market in all 11 states where it participates, both on and off the exchange, for plan year 2027.
When can patients pick a new Marketplace plan for 2027?
Open enrollment on HealthCare.gov runs November 1 to January 15. Patients must pick a plan by December 15 for coverage that starts January 1.
What happens if a patient does nothing after their insurer leaves?
HealthCare.gov says it will enroll the person in a comparable plan, which may be with a different insurance company. The patient should read the insurer’s letter and check the new plan’s network.
Will my practice be in network with the new plan?
Not always. Check each new plan against your current contracts. If a new insurer enters your state, ask it about network enrollment as soon as you can.
How can my practice reduce January eligibility denials?
Verify coverage for every patient at every visit in early 2027, scan new insurance cards, and update payer and member ID fields before the claim goes out.
Are more patients underinsured in 2026?
Yes. The Commonwealth Fund found that 46% of working age adults were uninsured, had a coverage gap or were underinsured in 2026.
Where should my practice start?
Start by finding which of your patients sit in exiting plans and how many January claims could bounce. WeBill Health works as a revenue defense partner for independent practices. Our coding experts review every claim against internal payer rule libraries built by specialty and carrier before it goes out, and we hold a 98% clean claim rate. Request a Revenue Defense Audit and we will show you where coverage changes may cost you payments in 2027.
Sources
- KFF: Tracking Insurer Participation Changes in the ACA Marketplaces in 2027 (updated October 28, 2026)
- Commonwealth Fund: The State of Health Insurance Coverage in 2026 (October 22, 2026)
- McIntyre A, Stone B, Lim KS, Shepard M, Sommers BD. Massachusetts Marketplace Disenrollment Following Enhanced Subsidy Expiration. JAMA. Published online October 29, 2026.
- HealthCare.gov: When can you get health insurance?
- HealthCare.gov: Automatic re enrollment keeps you covered
