Courtney Mroch was already paying a high price for health insurance when she learned her insurer, Cigna, was pulling out of Tennessee’s Affordable Care Act marketplace.

The 56-year-old Nashville resident has diabetes and asthma and is a cancer survivor. She pays $1,250 a month for a silver plan this year, up from $850 a month in 2025 — more than her family’s mortgage. To keep costs down, her husband is enrolled in a separate, non-ACA plan that’s less expensive.

“Who knows who will cover me in 2027 or how much more it’ll cost,” Mroch said.

Many Americans are heading into ACA open enrollment with the likelihood of higher premiums and fewer insurance companies to choose from. In most states, the enrollment period begins Sunday, giving people who buy their own coverage about two months to compare plans for next year.

Insurers who offer ACA plans are proposing a premium increase of about 15%, on average, for 2027 — the second straight year of double-digit increases, according to an analysis from KFF, a nonpartisan health policy research group, that looked at public filings from insurers across all 50 states and Washington, D.C.

At the same time, 11 insurers have announced plans to leave the ACA marketplaces in 2027 in at least some states where they currently offer coverage, according to KFF. Among them is Cigna, which will exit all 11 states where it offers ACA plans and has more than 350,000 ACA enrollees. Six insurers have announced plans to enter new marketplaces.

“The main takeaway is that more insurance companies are leaving the marketplace than coming in,” said Cynthia Cox, director of the program on the ACA at KFF.

For people shopping for coverage, that could mean fewer insurers to choose from and more people having to switch plans.

“This is going to create a lot of discontinuities in care and coverage for people,” said Miranda Yaver, an assistant professor of health policy and management at the University of Pittsburgh. “If you have a doctor who doesn’t accept the fewer number of options that are available to you, that can be very disruptive, especially if you’re someone who has a chronic illness.”

“And if the fewer available price points don’t work for you, are you going to remain covered?” she added.

Why are insurers leaving?

The departures come after the enhanced tax credits expired at the end of 2025, leading ACA enrollment to fall by roughly 3 million.

Some healthier people moved to cheaper but worse coverage or dropped insurance altogether. Those who remained on their plans tended to have greater health needs and higher medical costs.

Overall, that can make the marketplace less profitable for insurers as healthcare costs rise, said Jennifer Chumbley Hogue, an insurance broker in Texas.

From the consumer perspective, that means “constant upheaval, whether it’s the plan pulling out or the subsidies have changed or the doctor network has changed,” Hogue said.

In an email, a Cigna spokesperson pointed to April comments from CEO Brian Evanko, who said that leaving the ACA marketplace aligns with goals to position the company’s “core healthcare businesses for sustainable growth.”

For some families, rising premiums alone had already forced difficult financial decisions.

Denise O’Connor and her husband saw their monthly premiums in Colorado more than double this year, from just over $900 to about $2,300, forcing them to dip into their retirement savings.

The O’Connors are also covered by Cigna. She plans to work with a broker to find another plan, but her husband is also considering going uninsured for about six weeks until he qualifies for Medicare.

“It’s a worry,” she said. “He’s healthy, but anything can happen at any time.”

Mark Lathrop, who lives in Idaho and owns a winery just across the state line in Washington, said he and his wife are also looking for new coverage after their insurer, PacificSource, decided to leave the ACA marketplace.

The couple is already facing higher costs. They don’t qualify for the standard ACA subsidies, and Lathrop said a comparable plan for 2027 would cost about $17,600, up from about $16,000 last year. He needs an annual MRI to monitor a spinal cord injury, which costs $2,400, making a plan with a lower deductible important. “We don’t know what we are going to do yet,” he said.

In a statement, a PacificSource spokesperson said the decision to exit the ACA marketplace was not “made lightly” and was made to ensure it can “continue fulfilling our mission and serving members for the long term amid growing pressures across the healthcare industry.”

Yaver said the changes could undermine public support for the ACA. As fewer people enroll and those who remain face higher costs and fewer options, the marketplace could become less attractive to consumers — weakening the law without the Trump administration and Republicans ever having to repeal it.

A recent KFF poll found overall public favorability toward the ACA dropped to 58% from 64%. “We don’t see the repeal and replace of 2017, but we’re making it much harder for patients to remain on these plans,” Yaver said.

Hogue urged enrollees to review their options when open enrollment begins, rather than rely solely on the notices they receive in the mail. The premium and subsidies available to them, she said, may be different from the amounts listed in those letters.

“It’s worth the five minutes to take a look,” she said.