Large health insurance carriers are adding coverage in additional counties for the 2027 Affordable Care Act marketplace, while numerous rivals are preparing to withdraw amid pricing pressures and regulatory uncertainty.
Centene and Oscar add counties
Centene, which holds the top spot among ACA providers nationwide, will extend its network to 55 more counties across Alabama, Iowa, Illinois, Louisiana, Michigan, New Jersey and Texas for the upcoming year. Oscar Health, a rapidly expanding exchange participant, plans to introduce coverage in 140 additional counties, marking its inaugural entry into South Carolina.
The Tuesday press releases highlight that certain leading exchange players remain committed to the ACA, viewing the retreat of rivals as a chance to capture additional members. Oscar Health, serving roughly 2.9 million individuals through the marketplace, is in the midst of an extensive multi-year growth strategy. Company officials disclosed at an investor-day event last month that Oscar aims to increase its presence by 400 to 600 counties through 2029, a plan supported by unusually high earnings recorded in the first half of the current year.
UnitedHealthcare shifts focus
For Centene, the new county entries offset its plan to withdraw from two states in the coming year as it concentrates on more lucrative territories. UnitedHealthcare, the nation’s biggest private health insurer and a major ACA participant, will discontinue its marketplace offerings in Georgia next year; nevertheless, its overall coverage area—approximately 1,300 counties—remains stable, indicating expansion within the other 29 states where it operates.
A company representative affirmed that UnitedHealthcare has increased its county count in several states, keeping the aggregate figure roughly the same. “We will continue to carefully evaluate exchanges on a state-by-state basis each year to assess future opportunities as this market matures and develops,” Eric Hausman, UnitedHealth’s vice president of media relations, said.
Spokespersons for two additional leading ACA carriers, Health Care Service Corporation, which provides exchange plans in five states, and GuideWell, a prominent Florida provider with offerings in all 67 counties of the state, said their service territories will remain unchanged for 2027.
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Risk pool shifts and rate hikes
After a challenging year on the exchanges, insurers are adjusting their strategies. The expiration of enhanced ACA subsidies at the close of 2025 triggered a sharp drop in sign-ups. Data from June indicate that enrollment in the marketplace decreased by over 4.6 million individuals, per the Kaiser Family Foundation, a decline exceeding most analysts’ forecasts as many consumers, confronted with soaring monthly premiums, abandoned their plans throughout the year.
The outcome is a reduced and seemingly less healthy risk pool, since individuals in better health are more prone to forgo coverage, a trend that could increase insurers’ costs. Concurrently, policies from the Trump administration intended to curb fraud on the exchanges have unintentionally stripped legitimate participants of their coverage, adding further market volatility.
A number of insurers have concluded that continuing in the marketplace is no longer worthwhile: about twelve carriers have announced intentions to leave the ACA exchanges after the current year, either statewide or in specific markets where they are active. Companies such as Cigna Healthcare, Baylor Scott & White, CareSource, Providence Health Plan, Molina and additional firms plan withdrawals that could impact hundreds of thousands of members across several states.
The insurers that stay in the exchanges are seeking double-digit premium hikes for a second consecutive year, with a median increase of 15% proposed for 2027. The Commonwealth Fund notes this represents the steepest consecutive rise in marketplace rates since 2018.
New Offerings and Enrollment Timeline
Discounts are available at partners like Walgreens and the YMCA. Meanwhile, Oscar Health is introducing a plan for early retirees transitioning to Medicare and expanding options for menopausal women. Open enrollment for 2027 ACA plans begins Nov. 1.
Product changes
Providers are also revising their product offerings, moving toward more customized plans that focus on particular health needs such as chronic disease management, in hopes of drawing additional enrollees and curbing medical costs.
