Some prominent insurers participating in the Affordable Care Act (ACA) exchanges are set to extend their reach into new counties for 2027, despite other companies pulling back amid ongoing economic pressures and policy challenges.
Centene, recognized as the largest ACA insurer in the U.S., plans to expand into 55 additional counties across Alabama, Iowa, Illinois, Louisiana, Michigan, New Jersey, and Texas next year. Oscar Health, a rapidly growing presence in the exchanges, is adding 140 new counties, marking its entry into South Carolina for the first time.
These announcements, made via press releases on Tuesday, indicate a continued commitment to the ACA by these major players, who may seize growth opportunities as competitors withdraw, leaving members in search of new coverage options.
Oscar, which currently serves around 2.9 million ACA enrollees, is engaged in a significant multi-year expansion in the ACA exchanges and anticipates adding between 400 and 600 new counties by 2029. This growth is reportedly powered by record profits in the initial half of this year, according to executives referenced during an investor event last month.
On the other hand, Centene’s planned county additions come despite its decision to exit two states next year as it pivots toward more profitable markets.
While Centene currently covers over 3.5 million individuals on the ACA exchanges, it will no longer offer Marketplace plans in Delaware and New Hampshire next year. Thus, the addition of 55 counties won’t actually alter Centene’s geographic presence for 2027. However, a spokesperson did not provide details at the county level when requested.
Similarly, UnitedHealthcare, the largest private insurer in the U.S. and a significant player in the ACA, will discontinue its ACA plans in Georgia next year. Yet, its overall footprint of about 1,300 counties remains stable, indicating possible expansions in its other 29 states.
A spokesperson confirmed that UnitedHealthcare has indeed added counties in certain states, so the total remains roughly the same.
“We’ll continue to assess exchanges individually each year to explore future opportunities as this market evolves,” remarked Eric Hausman, UnitedHealthcare’s vice president of media relations.
Meanwhile, two significant ACA insurers—Health Care Service Corporation, which provides coverage across five states, and GuideWell, a key operator in Florida with plans available in all 67 counties—have indicated no changes to their footprint for 2027, as per their spokespeople.
Elevance and Kaiser Permanente have not responded regarding their plans for 2027.
The backdrop for these adjustments is a challenging year for insurers in the exchanges. The expiration of enhanced subsidies for ACA coverage at the end of 2025 led to a significant drop in enrollment. By June, enrollment had declined by over 4.6 million people, a sharper fall than anticipated, as many Americans, faced with soaring monthly premiums, opted out of the exchanges.
This situation has resulted in a reduced, seemingly less healthy risk pool, as those in better health are more likely to drop their coverage, which is expected to hike expenses for insurers. Furthermore, policies introduced during the Trump administration aimed at curbing fraud have also led to legitimate participants losing their coverage, adding to the uncertainty within the markets.
The ongoing turmoil has prompted many insurers to reconsider their participation: about a dozen carriers have announced plans to withdraw from the ACA marketplaces post-2026, affecting multiple states.
These exits—affecting companies like Cigna Healthcare, Baylor Scott & White, CareSource, and Molina—are expected to impact hundreds of thousands of enrollees.
For those remaining in the market, there seems to be a trend toward requesting significant rate hikes for the second consecutive year, with a median 15% rate increase proposed for 2027. This marks the highest rate increase in the marketplace since 2018, according to the Commonwealth Fund.
Insurers are also rethinking their plan offerings, striving for more personalization. The idea is that by tailoring plans to meet specific needs, including chronic disease management, they can attract more members and better manage expenses.
Centene, through its Ambetter subsidiary, is launching condition-specific plans for health issues like congestive heart failure, diabetes, and asthma—options that have gained significant popularity among members, as noted in their recent announcement.
In addition, Centene will continue providing around-the-clock virtual care, implement rewards for members participating in health activities, and offer discounts through partners like Walgreens and YMCA.
Oscar is also rolling out a plan designed to assist early retirees transitioning from ACA coverage to Medicare. They are expanding offerings specifically for women experiencing menopause, as well as concierge care and discounts at Hy-Vee supermarkets.
Open enrollment for ACA plans in 2027 is scheduled to begin on November 1 in most states.
