At least seven insurers will stop selling Affordable Care Act marketplace plans in 2027, and the Commonwealth Fund says their exits will force consumers in 20 states to switch to new plans next year. The count comes from an October 8 post by three Georgetown University health policy researchers, Stacey Pogue, Abigail Knapp and Justin Giovannelli, who also warn that premiums are set to climb again.

The seven insurers and the 20 states

The authors, who work at Georgetown’s Center on Health Insurance Reforms, name the seven in their Commonwealth Fund post: Baylor Scott & White Health Plan, CareSource, Cigna, Medica, Mending (formerly Taro Health), PacificSource and Providence Health Plan. They put the number at “at least seven,” so the list may grow. The post does not name the 20 states where people will have to move.

The insurers cite escalating costs, declining enrollment and shifting regulations. For a person whose plan is ending, the practical result is a new set of plans and a provider network to check, all while prices rise.

So what does a marketplace customer do when the insurer is leaving? The decision is which of the remaining plans fits the household’s doctors, drugs and budget, and it has to be made inside a fixed window.

Open enrollment for 2027 coverage starts November 1, and December 15 is the last day to pick a plan that starts January 1.

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Prices heading into the 2027 sign-up

The post says insurers have proposed a median 15 percent rate increase for 2027, with wide variation by company and state. That follows a year in which 2026 premiums rose more than 20 percent, and the authors say the average benchmark premium before tax credits went from $497 a month in 2025 to $625 in 2026. They call back-to-back double-digit increases the highest in the marketplace since 2018. Over the five years before 2026, the benchmark plan’s premium rose about 2 percent a year.

The enhanced premium tax credits that were in place from 2021 to 2025 were not extended by Congress at the end of 2025. The post says people with incomes above $63,840 for an individual, or $132,000 for a family of four, get no financial help with the increases. As an example, it estimates that a 40-year-old just above that line who paid $445 a month after tax credits in 2025 could owe $719 a month in 2027. That number is the authors’ estimate, built from the 2026 average silver benchmark premium raised 15 percent.

State regulators are already reporting numbers. The Pennsylvania Insurance Department says it approved a 15.97 percent average increase for the individual market in 2027, after insurers asked for 17.14 percent, and it says it denied $94.7 million in premium increases. For small employer plans it approved 10.28 percent after a request for 11.49 percent. The department says $845 million more was paid in 2025 medical and prescription drug claims than in 2024, up 13 percent, and that federal health care cuts continue to drive up costs for Pennsylvania families.

The authors also point to shrinking enrollment. They cite Wakely, an actuarial consulting firm, for an expected 17 to 26 percent drop in marketplace enrollment in 2026, and they say new paperwork burdens and immigration-related restrictions will make signing up harder for some people. The 2027 rate filings, they write, cite the end of the enhanced credits and falling enrollment as drivers of the increases.

The dates that decide when a new plan starts

HealthCare.gov’s dates and deadlines page lists three. Starting November 1, people can apply for 2027 coverage or update an application. December 15 is the last day to enroll in or change plans for coverage to start January 1, and anyone who picks a plan by then and pays the first premium has coverage on that date. Open enrollment ends January 15, the last day to enroll in or change marketplace plans for the year.

A person who waits past December 15 can still enroll through January 15, but the January 1 start is no longer available. The page also says that outside open enrollment, people can change marketplace plans only if they qualify for a special enrollment period, such as after moving or losing other coverage.

Picking a replacement before December 15

Begin at HealthCare.gov, where the 2027 plans open for browsing on November 1. Before logging in, write down the current plan’s premium after tax credits, its deductible and out-of-pocket maximum, the doctors and hospitals the household uses, and every prescription with its dose.

Then compare the plans the same way. Check whether each doctor is in the new plan’s network, which tier each drug is on, and what the monthly premium is after any tax credit. A cheaper plan with the wrong network can cost more over a year than a pricier one that covers the people a household sees. With insurers proposing a median 15 percent increase, the plan a household moves to may cost more than the one it is leaving.

Keep the notice from the leaving insurer, and keep a record of the plan selected and the date. Enrolling by December 15 and paying the first premium is what produces coverage on January 1.

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This article was produced with AI assistance and edited for accuracy against the sources linked above.