Major insurers continue to pull back from the ACA marketplace as enrollment declines, bronze plan uptake surges and the expiration of enhanced premium subsidies reshape the risk pool heading into 2027.
1. The latest exits
Cigna will exit the ACA business at the end of 2026, the company said April 30. The insurer’s individual and family plans cover 369,000 lives across 11 states.
“This is small business for us today, and it’s been shrinking in recent years,” incoming CEO Brian Evanko said during the company’s first quarter earnings call.
Baylor Scott & White Health Plan said in April it will also no longer offer individual marketplace plans past 2026. The plan covers about 100,000 enrollees, or roughly 2.6% of Texas ACA customers.
Aetna exited the ACA market at the end of 2025, forcing approximately 1 million enrollees across 17 states to find new coverage for 2026. CVS Health cited continued financial underperformance as the reason for the exit.
2. Broader market pullback
Even insurers that have not announced full exits from the market have been pulling back, with many regional insurers shrinking service areas last year.
UnitedHealthcare also expects to shrink its ACA enrollment by roughly one-third in 2026 as it prioritizes margin recovery. The company previously pledged to refund any 2026 profits from its ACA plans, and noted exchange margins are expected to land around 1% in 2026 after repricing.
“Our approach in the ACA market continues to be directed toward the bronze and gold tiered products, where member mix and utilization rates are largely aligned with plan,” UnitedHealthcare CEO Tim Noel said during the company’s first quarter earnings call.
3. Centene absorbs enrollment and mix pressure
Centene, the largest marketplace carrier, said its ACA membership fell to 3.6 million in the first quarter, down from 5.6 million a year earlier. CEO Sarah London said April 28 that over one-third of the insurer’s marketplace members are now enrolled in bronze plans, less than half are in silver plans, and the remaining share have gold coverage.
Ms. London said membership losses across most markets were less than expected, “which suggests that more healthy members stayed in the market in aggregate and that our pricing was appropriate relative to the overall market morbidity.”
Despite the transitions, Centene had strong silver retention, with 75% of that tier’s membership stemming from renewals. Ms. London foresees “a meaningful risk adjustment offset” as Centene’s silver plans retain higher-acuity members. She added that Centene did not “go as hard at a bronze strategy.”
4. Overall enrollment
ACA enrollment reached 23.1 million in 2026, a 5% decrease from 2025, according to a CMS report released March 27. While that represents a drop of about 1.2 million consumers from the prior open enrollment period, 2026 enrollment remains 8% higher than 2024 and 41% higher than 2023.
The composition of remaining enrollees has shifted toward lower-cost, higher-deductible plans. Bronze plan enrollment grew 26% nationally, from 7.3 million to 9.2 million, even as total enrollment fell. The share of ACA enrollees in bronze plans increased from 30% in 2025 to 40% in 2026, according to CMS data. Texas saw the largest increase in bronze enrollment from 2025 to 2026, while West Virginia saw the largest decrease.
The average out-of-pocket premium after advanced premium tax credits is $178 in 2026, up from $113 in 2025. Nationally, about 14% of ACA policyholders in 2026 failed to pay their first monthly premium bill, according to the Wall Street Journal. In a typical year, the rate is in the mid-single-digit range.
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