ACA marketplace shoppers are heading into 2027 with fewer insurer choices and higher costs: insurers have proposed average premium increases of about 15%, while 11 insurers plan to leave at least some marketplaces and six plan to enter new ones.

The pullback follows the expiration of enhanced ACA tax credits at the end of 2025, after which enrollment dropped by roughly 3 million. Some healthier people shifted to cheaper, less comprehensive plans or dropped coverage, leaving a higher-cost pool as healthcare costs rise.

Cigna plans to exit all 11 states where it offers ACA plans, affecting more than 350,000 enrollees. PacificSource is also leaving some markets, prompting customers including Courtney Mroch in Tennessee and Mark Lathrop in Idaho to look for replacement coverage.

Families are already reporting steep increases: Mroch’s silver plan rose from $850 a month in 2025 to $1,250 this year, while Denise O’Connor and her husband saw premiums rise from just over $900 to about $2,300 monthly. Lathrop estimates comparable 2027 coverage will cost about $17,600, up from roughly $16,000 last year.

Those costs are forcing difficult choices, from dipping into retirement savings to considering temporary gaps in coverage. Lathrop also needs an annual MRI to monitor a spinal cord injury, making a lower-deductible plan especially important.

With fewer plans available, some people may have to change coverage, doctors or treatment arrangements—a particular disruption for those with chronic illnesses—and unaffordable prices could push some consumers to go uninsured.

Broker Jennifer Chumbley Hogue urges enrollees to compare plans during open enrollment instead of relying only on mailed notices, since the premiums and subsidies in those letters may not match what they will actually face.

Researchers and brokers warn that repeated shifts in insurers, subsidies and provider networks could erode public support for the ACA; a recent KFF poll found the law’s favorability fell to 58%, from 64%.