Nine insurers have announced they will leave ACA Marketplaces for 2027, either entirely or in selected states, according to KFF’s insurer-participation tracker as of September 15, 2026 — and the largest of them, Cigna, is withdrawing from all 11 states where it sells individual plans, affecting about 369,000 enrollees by the company’s own April count as reported by STAT. Those people have received, or will receive, a written notice that their plan ends on December 31. What happens next depends on whether they act before December 15, whether the plan the Marketplace picks for them fits, and whether their agent is in the conversation before the letter arrives rather than after.
Premier Health Solutions is a third-party administrator based in Frisco, Texas that has been administering health and supplemental benefit plans since 2012. PHS works with independent agents and agencies across 48+ states, partnering with A-rated insurance carriers. PHS does not sell insurance; the products described here reach consumers through licensed independent agents, and PHS handles the enrollment, billing and member service behind them. This article explains what the 2027 exits mean for affected enrollees and what agents should tell the clients who are about to get an exit letter.
Who is leaving, and where
The exits are concentrated in a handful of states, and Texas is one of the states losing more than one carrier. KFF counts nine carriers exiting for 2027 and six entering new state Marketplaces, so the net effect varies by county. Becker’s Payer Issues maintains a running list that reaches 11 because it also counts partial withdrawals such as Cox HealthPlans and ConnectiCare; the table below draws on it and on the carriers’ own announcements. Enrollees should confirm their own carrier’s status from the discontinuation letter, not from a list.
| Insurer | Markets exiting for 2027 | Reported enrollees affected |
| Cigna | Arizona, Colorado, Florida, Georgia, Illinois, Indiana, Mississippi, North Carolina, Tennessee, Texas, Virginia (all individual-market business) | About 369,000 (STAT, April 30, 2026) |
| Baylor Scott & White Health Plan | Texas individual market (also exiting Medicaid) | About 100,000 (Becker’s, April 15, 2026) |
| Molina Healthcare | Reducing Marketplace footprint from 14 states to 6 | Not disclosed |
| Medica | Iowa, Kansas, Oklahoma | Not disclosed |
| Centene | Delaware, New Hampshire | Not disclosed |
| CareSource | Indiana, Ohio, West Virginia | Not disclosed |
| PacificSource | Idaho, Montana, Oregon | Not disclosed |
| Providence Health Plan | Oregon | Not disclosed |
| ConnectiCare Insurance Company | Connecticut exchange (Access Health CT) plans; affiliate ConnectiCare Benefits remains on the exchange | Not disclosed |
| Cox HealthPlans | Missouri Marketplace (keeps off-exchange plans in a handful of counties) | Not disclosed |
| Mending (formerly Taro Health) | Maine, Oklahoma | Not disclosed |
Cigna’s reasoning is instructive. Its then chief operating officer, Brian Evanko, told analysts the company “did not see a way to meaningfully grow” the individual business and would concentrate on its specialty, pharmacy and employer segments. Baylor Scott & White’s chief executive, Pete McCanna, pointed to “high turnover” in the Marketplace and Medicaid populations. Both are describing the same market: after the enhanced premium tax credits expired on December 31, 2025, Marketplace sign-ups fell by more than a million, roughly 21% of HealthCare.gov sign-ups were dropped in the first months of 2026, mostly for non-payment of the first premium (CMS internal data reported by NOTUS and Fierce Healthcare in May), and insurers have proposed a median 15% premium increase for 2027. The 2026 ACA coverage playbook covers the subsidy cliff itself; this piece is about the carrier exits it triggered.
What happens to an enrollee whose insurer leaves
On HealthCare.gov, an enrollee who does nothing will be moved into a plan from a different insurer; whether that plan is any good for them is a separate question. The federal Marketplace’s own guidance is direct: if the enrollee’s insurer is not offering plans for next year, the Marketplace will re-enroll them with a different company. The enrollee should receive two letters by November 1 — one from the departing insurer and one from the Marketplace naming the plan they will be placed in if they take no action.
| Step | What the rules say | Date or window |
| Discontinuation notice | An insurer discontinuing a product must give enrollees written notice at least 90 calendar days before coverage ends and offer any other coverage it still sells on a guaranteed-availability basis. An insurer leaving a state’s entire individual market must give at least 180 days’ notice and is barred from re-entering that market for five years. (45 CFR 147.106) | Letters for a December 31 termination are due by early October for a product discontinuation and were due by early July for a full market withdrawal |
| Marketplace notice | HealthCare.gov sends its own letter naming the plan the enrollee will be moved into if they take no action | By November 1, 2026 |
| Open enrollment | 2027 open enrollment on HealthCare.gov runs November 1, 2026 through January 15, 2027; enrollment by December 15 is required for January 1 coverage | Nov 1 – Jan 15; Dec 15 for Jan 1 start |
| Automatic re-enrollment | If the enrollee has not chosen a plan by December 15, the Marketplace places them in a plan from another insurer: the same metal level and product type with the most similar provider network, and among those the lowest premium (45 CFR 155.335) | Effective January 1, 2027 |
| Special enrollment period | Loss of coverage because a plan is discontinued is a qualifying event; the enrollee generally has 60 days before and 60 days after the loss to pick a plan, though enrolling after December 31 means a later effective date and a gap | Roughly November 1 through March 1, 2027 |
| Off-exchange enrollees | No entity automatically re-enrolls someone whose coverage was bought directly from an insurer; they must choose a new plan themselves | Same deadlines apply |
| State-based exchanges | Auto-enrollment practices vary; several of the exiting carriers’ states (Colorado, Georgia, Virginia, Idaho, Illinois, Maine, Connecticut and, from 2027, Oregon) run their own exchanges with their own crosswalk rules. Connect for Health Colorado has said Cigna enrollees will not be placed in a new plan automatically for 2027 and must choose one themselves | Confirm with the state exchange |
Regulatory status verified as of September 17, 2026. The HealthCare.gov open-enrollment dates above are the ones CMS reaffirmed in its July 31, 2026 statement; a Fourth Circuit appeal of the court decision that vacated parts of the 2025 Marketplace Integrity rule remains pending, so they are worth re-checking before December.
Two things about automatic re-enrollment deserve emphasis in a client conversation. First, the Marketplace’s matching algorithm looks at metal level, product type and network similarity; “most similar network” is not the same as “includes your doctor,” and it does not check prescriptions at all. Second, auto re-enrollment uses the client’s most recent application plus whatever updated income data the Marketplace can obtain, so a household whose income changed in 2026 should update the application during open enrollment rather than trust the redetermination to get the 2027 credit right.
Why the replacement plan will cost more, whatever it is
The client is not moving from one plan to an equivalent one; they are moving into a 2027 market with higher premiums and, for many, thinner benefits. Peterson-KFF’s review of 2027 rate filings found a median proposed increase of 15% across 276 Marketplace insurers. In Texas, the preliminary average requested increase in the individual market is 14.1%, per ACA Signups’ compilation of the state filings as of August 28, 2026; the final approved figure may differ. Those increases land on top of 2026, when the loss of enhanced tax credits raised average net premium payments for subsidized enrollees by about 58%.
The response to that pressure is already visible in the data. The Commonwealth Fund reported in June that early data from several state-based Marketplaces showed enrollees shifting from silver to bronze plans between 2025 and 2026, with bronze’s share rising from roughly 30% to 40%, and that about 14% of people who signed up for 2026 coverage in those states never paid the January premium. A client who is crosswalked into a bronze plan, or who chooses one to hold the premium down, is trading a lower monthly bill for a deductible that can run several thousand dollars before the plan pays much of anything.
| Client situation after the exit letter | What to expect | Where a supplemental layer fits |
| Subsidy-eligible, stays at the same metal level | Higher gross premium, partly offset by a credit at 2026 (non-enhanced) levels | Accident or hospital indemnity to cover the deductible on a silver or bronze plan |
| Downshifts to bronze to control premium | Deductible and out-of-pocket maximum rise sharply | Accident, hospital indemnity and critical illness as the layer that pays before the deductible is met |
| Above the subsidy line, healthy | Full-price 2027 premium; may consider going without | Short-term medical only as a defined bridge, with the exclusions stated plainly; fixed indemnity as a supplement to something, never as the only coverage |
| Off-exchange enrollee who misses December 15 | No auto re-enrollment; a February 1 or later effective date means a coverage gap | Short-term medical for the gap month; direct primary care for routine needs while the gap closes |
What to tell clients now
Ask every Marketplace client which insurer they have before the letters go out, because an agent who calls in October is a resource and an agent who calls in January is a salesperson. The exiting carriers have been public for months. Any client on Cigna, Baylor Scott & White, Molina in an exiting state, or one of the regional plans above should hear from their agent before November 1.
Do not let the crosswalk choose the plan. The auto-assigned plan is a floor, not a recommendation. Run the client’s doctors, hospital and prescriptions against the new carrier’s network and formulary before December 15. In counties that lost a carrier, the network the client is used to may not exist in any remaining plan, and the client should hear that from the agent rather than from a front-desk receptionist in February.
Re-do the income estimate. Automatic re-enrollment carries forward the prior application. A client whose household income rose or fell in 2026 should update it during open enrollment so the 2027 tax credit is right, particularly now that the enhanced credits are gone and, since January 1, 2026, the subsidy cliff at 400% of the federal poverty level is back in force.
Explain the deductible before the client meets it. For a household moving into a bronze plan, the conversation about accident, hospital indemnity and critical illness coverage is a conversation about the full deductible — often several thousand dollars — on any serious claim. The product stacking guide lays out the combinations; the hospital indemnity explainer and the fixed indemnity guide cover what each product pays and what it does not. None of these products replace the Marketplace plan; every one of them is sold with a written disclosure that says so.
Treat short-term medical as a gap tool, not a landing spot. A client whose off-exchange plan ends December 31 and who cannot get a January 1 effective date has a one-month problem, and short-term medical as bridge coverage is built for exactly that problem. A client who is priced out of the Marketplace entirely and has a chronic condition does not have a one-month problem, and short-term medical is not the answer.
Make the paperwork legible. A client moving carriers, adding a supplemental plan and possibly changing agents in the same 60 days is going to see unfamiliar names on bank statements. Members enrolled in PHS-administered products see PHS-HEALTH-BILL on their statement, and the how to verify your benefits administrator post exists so agents can send it before the first draft posts rather than after the client calls the bank.
Agents who hold Marketplace appointments can enroll clients in ACA plans through PHS-administered arrangements; the ACA health insurance page describes how that works. The employer side of the same story — small groups facing double-digit renewals and considering dropping coverage — is covered in what agents should tell clients whose employers may drop group coverage in 2027.
A closing note on timing
The exit letters and the Marketplace’s own notices will reach affected households in October and by November 1, and the deadline that determines whether a client starts 2027 in a plan they chose or a plan an algorithm chose is December 15. For the roughly half-million people covered by Cigna and Baylor Scott & White alone, and the unreported numbers behind the other exits, the difference between those two outcomes is usually one phone call from an agent who knew the letter was coming.
