Affordable Care Act (ACA) marketplaces are experiencing a wave of insurer withdrawals as plans prepare for the 2027 plan year. Citing sharp increases in medical utilization, rising drug costs, and the looming expiration of the enhanced premium tax credits, major carriers are downsizing their geographic footprints or exiting the market entirely.
We mapped every announced exit down to the county, combining the CMS QHP Landscape for HealthCare.gov states with the state-based exchange filings behind our validated 2026 baseline. When a carrier pulls out of a state entirely, its full 2026 footprint in that state disappears in 2027 — so each exit here reflects every county the carrier serves today. In total, the announced withdrawals impact 19 states and 836 counties.
Source: SERFF Filings, News Releases
The financial squeeze behind the exits
For the past few years, the ACA exchanges have enjoyed record-high enrollment driven by enhanced federal subsidies. However, insurers are reporting that the risk pool has deteriorated as medical claims spike. Commercial risk-adjustment transfers and high medical loss ratios (MLRs) are putting intense pressure on regional and national plans alike.
With the enhanced subsidies scheduled to expire at the end of 2025, enrollees will face higher net premiums in 2027, which is expected to cause healthier enrollees to drop coverage first—compounding the financial pressure on carriers.
Mapped: county-level exit footprints
The map below shows the number of counties where one or more of the exiting insurers (Cigna, Medica, PacificSource, Baylor Scott & White, CareSource, Mending, Providence, and Centene/Ambetter) are withdrawing their plans. Counties are shaded by how many of these carriers are leaving.
Insurers exiting the market
The table below details the full county-level footprint each withdrawing insurer leaves behind in the individual medical market:
| Carrier | Impacted Counties | States |
|---|---|---|
| Cigna | 356 | AZ, CO, FL, GA, IL, IN, MS, NC, TN, TX, VA |
| Medica | 137 | IA, KS, OK |
| PacificSource | 136 | ID, MT, OR |
| Baylor Scott & White | 104 | TX |
| CareSource | 92 | IN |
| Mending | 45 | ME, OK |
| Providence | 36 | OR |
| Centene (Ambetter) | 10 | NH |
Key highlights from the data
- Cigna has by far the largest exit footprint, abandoning the marketplace across 356 counties in eleven states — Arizona, Colorado, Florida, Georgia, Illinois, Indiana, Mississippi, North Carolina, Tennessee, Texas, and Virginia — affecting roughly 369,000 members.
- Medica (137 counties across Iowa, Kansas, and Oklahoma) and PacificSource (136 counties across Idaho, Montana, and Oregon) are the next-largest regional pullbacks.
- CareSource exits Indiana's marketplace entirely (92 counties), leaving roughly 60,000 members to find new coverage, while Baylor Scott & White drops all 104 of its Texas counties.
- Texas, Iowa, and Indiana see the deepest disruption, with 109, 99, and 92 counties impacted respectively.