Six health insurers have confirmed they are leaving the Affordable Care Act marketplace for the 2027 plan year, a wave that will force roughly 650,000 enrollees across a third of the states to pick a new carrier before this winter’s open enrollment closes. Cigna Health, CareSource, PacificSource, Baylor Scott and White, Providence Health and the startup Mending are walking away from state exchanges after two straight years of premium spikes tied to the expiration of enhanced federal subsidies. The retreat concentrates coverage decisions in fewer companies and leaves some counties with only one marketplace insurer left standing.
Cigna’s Exit Alone Displaces 369,000 Enrollees Across Eleven States
Cigna’s departure is the single largest domino in the 2027 shakeup. The insurer will exit all 11 states where it currently sells marketplace plans — Arizona, Colorado, Florida, Georgia, Illinois, Indiana, Mississippi, North Carolina, Tennessee, Texas and Virginia — displacing about 369,000 enrollees. Cigna’s incoming chief executive, Brian Evanko, told analysts in late April that the company saw no viable path to grow an on-exchange business that had already shrunk 17% from a year earlier, a business KFF’s own tracking put at just over 350,000 members based on Cigna’s first-quarter investor filing.
CareSource and Baylor Scott and White are retreating for a different reason. CareSource, a nonprofit built around Medicaid managed care, is dropping marketplace plans in Indiana, Ohio and West Virginia, where it covers close to 90,000 people. In Texas, Baylor Scott and White Health Plan is leaving both the marketplace and Medicaid entirely, stranding roughly 100,000 enrollees. Unlike Cigna’s single strategic pullback from an underperforming national product line, both are hospital-system-affiliated plans exiting because an individual market with a shrinking, sicker risk pool no longer supports the provider networks built around it.
Combined, those three insurers alone account for more than 550,000 of the roughly 650,000 people who will need new coverage, a figure Georgetown University’s Center on Health Insurance Reforms attributed to healthinsurance.org’s tally of the six confirmed 2027 exits. The remaining displacement is split between Providence, PacificSource and Mending, whose enrollee bases are smaller but concentrated in states where marketplace competition was already thin before 2027.
Oregon’s Marketplace Narrows to Four Carriers as Regional Insurers Retreat
Oregon shows what a thinning marketplace looks like at the state level. PacificSource and Providence Health, which together cover nearly 96,000 enrollees across Oregon, Idaho and Montana, are both leaving after concluding they lack the scale to negotiate hospital rates the way national insurers can. Providence chief executive Erik Wexler said larger carriers have consolidated enough to operate more efficiently, leaving regional nonprofit plans like his in what he called an “untenable situation.” The exits will cut Oregon’s marketplace from six insurers to four, though the state’s insurance commissioner has said every county will still keep at least three plan options…