When a health insurance company decides to stop offering plans in a state's ACA marketplace, it is not just a business announcement. For tens of thousands of people who purchased their coverage through that insurer, it means a disruption to the plan they chose, the doctors in their network, the drugs on their formulary, and the cost-sharing structure around which they have been managing their health care.
This disruption happens with limited notice, creates real barriers for people managing chronic conditions, and is poorly understood by most people it affects — until it happens to them. At least seven health insurers have announced plans to leave the ACA Marketplace after 2026, affecting more than 650,000 enrollees across multiple states, including Cigna, which covers about 369,000 Marketplace enrollees across 11 states.
Why This Matters
ACA marketplace insurer exits are not rare. Since the ACA marketplaces opened in 2014, numerous major insurers have entered and exited state markets, particularly in rural areas with thin enrollment and high medical cost ratios. When an insurer exits:
- Enrollees receive a notice that their current plan will not be available in the next coverage year
- CMS provides a special enrollment period (SEP) that allows affected enrollees to select a new plan outside the regular open enrollment window
- If an enrollee does not actively select a new plan, they may be auto-enrolled in a different plan — but auto-enrollment choices may not match their care needs or provider preferences
The process sounds manageable, but in practice, it is more complicated than it appears for the patients most affected by it.
What We Know So Far
The Special Enrollment Period. Enrollees whose insurer exits receive a special enrollment period — typically starting 60 days before their plan ends and continuing for 60 days after it ends — to select a new plan. This SEP is a genuine benefit — without it, enrollees would have to wait until the next Open Enrollment period (now ending December 15 for HealthCare.gov states) while being uninsured. However, using an SEP effectively requires knowledge, time, and access to enrollment assistance that many people do not have.
The Network and Formulary Problem. The most significant practical problem for people with chronic conditions when their insurer exits is that their replacement plan may not include the same physicians, hospitals, or specialist practices, and may not cover the same drugs at the same cost-sharing tier.
For a person managing a chronic condition with a specific rheumatologist, oncologist, or cardiologist, a plan change that moves that provider out of network can force a choice between paying out-of-pocket to stay with a trusted provider or switching to an in-network provider they have never met. For a person on a specialty medication that was tier 1 on their prior formulary, the new plan may cover the same drug at tier 3 or not at all, dramatically changing monthly out-of-pocket costs.
The Navigator and Assister Gap. A significant portion of ACA marketplace enrollees enrolled with help from navigators, certified application counselors, or insurance brokers. When an insurer exits, those assisters may not be available in all areas, have the capacity to handle the volume of people needing re-enrollment help simultaneously, or be familiar with the specific plan options available in each affected person's area.
Auto-enrollment Risks. When enrollees do not actively choose a new plan during the SEP, CMS and state marketplaces typically auto-enroll them in a plan that most closely matches their prior plan's metal level, product type, and provider network. The auto-enrollment criteria are based on premium proximity and plan type — but they may not account for network adequacy for the enrollee's specific providers, formulary coverage for their medications, or cost-sharing preferences.
What Doctors and Experts Say
Patient advocates for people managing chronic conditions consistently emphasize the same point: the only way to avoid the most damaging consequences of a forced plan switch is to actively compare the available replacement plans using the specific physicians and drugs you need — not to rely on auto-enrollment or general plan quality ratings.
Healthcare.gov and state marketplace websites have provider search and drug formulary check tools that allow consumers to enter their specific physicians' names and medications to compare whether they are covered before selecting a plan. Using these tools before enrolling in a replacement plan is the single most important step a consumer can take.
What to Do If Your Insurer Is Leaving
When you receive a notice that your insurer is exiting the marketplace, do not ignore it. You have a specific SEP window — typically starting 60 days before your plan ends — to select a replacement plan.
Before selecting a replacement plan, check whether your current physicians and specialists are in-network in the replacement plans available to you. Use the provider search tool on healthcare.gov or your state marketplace.
Check whether your current prescription medications are covered under the replacement plan's formulary, at which cost-sharing tier, and whether any prior authorization requirements apply.
Contact your plan's current prescribers to ask whether they are in-network in the plans you are considering, and whether they accept the new plan's patients.
If you enrolled through a navigator, assister, or broker, contact them for help. If they are not available, contact your state SHIP (State Health Insurance Assistance Program) at 1-800-MEDICARE for free counseling.
If you have a specialty medication, check whether the replacement plan covers it, and if not, ask your physician about prior authorization, step therapy appeals, or whether switching to an alternative drug on the formulary is clinically appropriate.
Cost and Access: What Patients Should Know
Switching plans mid-year due to an insurer exit does not reset your deductible or out-of-pocket maximum — a specific protection built into ACA law. If you have already met $2,000 of your deductible when you switch plans, your new plan is required to credit that $2,000 toward your new plan's deductible. This protection is significant for people who have already had medical expenses in the current year.
For help understanding your options, KFF's health insurance marketplace guide provides an objective analysis of plan options and marketplace trends.
The Bottom Line
When an insurer exits your ACA marketplace, you have rights: a special enrollment period to select a new plan, no deductible reset, and access to plan comparison tools. But the practical work of finding a plan that keeps your doctors and medications covered at a cost you can manage requires active comparison before you enroll — not reliance on auto-enrollment. If your insurer is leaving, start comparing plans as soon as you receive the notice, and get free enrollment help from your state SHIP or a navigator if you need it.
