Marketplace Pulse: Increase in Exits by Individual Market Insurers

The Marketplace Pulse series provides expert insights on timely policy topics related to the health insurance marketplaces. The series, authored by RWJF Senior Policy Adviser Katherine Hempstead, analyzes changes in the individual market; shifting carrier trends; nationwide insurance data; and more to help states, researchers, and policymakers better understand the pulse of the marketplace.

There have been a number of announced exits from the marketplace for the upcoming 2027 plan year. Cigna announced its intent to exit the market in April and this was followed by several announcements by smaller regional plans, including Scott and White of Texas, Providence, and PacificSource.  Caresource announced its exit from Indiana.  These announcements come in the context of increased premiums and administrative costs in the individual market that have led to significant enrollment decline and increased morbidity. There may be additional exit announcements in the coming months, as states undergo the rate review process.

How extensive are these exits and how might they affect availability of insurance and the overall stability of the market?

Recent trends

The overall number of on-market offerings had already been falling, declining from 12,590 in 2025 to 11,684 in 2026, a reduction of about 7%. At the same time, off-exchange offerings increased significantly. This reduction reflected both a handful of complete exits and many more scale backs in participation.  The largest single exit in 2026 was from Aetna/CVS, a large national plan, which had on-market offerings in 626 counties in 2025. Other exits came from smaller regional, co-op and provider sponsored plans. Of the six other insurers that completely exited the market in 2026, many were small regional plans, including for example Chorus Community Health Plan in Wisconsin and the Montana Health Co-op in the Mountain West. Many other regional plans reduced their offerings significantly. While most of the large national insurers and blues plans other than Aetna made very few changes in their participation, Medicaid MCOs Molina and Caresource reduced their overall offerings by approximately 25%, and exited some states completely.  

The states most affected by reduced on-market participation were predominantly located in the Midwest and South. Kentucky and Illinois have state-based marketplaces.  Illinois, the state with the largest decline, was impacted by the exits of Carle, a regional plan, and Aetna.  North Carolina's loss of offerings was also driven by the Aetna withdrawal, in addition to significant reductions in footprint by CareSource. Aetna's exit was the main source of the change in offerings in Kansas. The exit of the Montana Co-op was responsible for the reduction of offerings in Wyoming. The complete exit of Caresource and a major pullback by Molina were the key factors in Kentucky. There were multiple sources of exit in Wisconsin, with complete exits and reductions by a number of regional plans, as well as an exit by Molina.

Number of insurers in counties

While the overall reduction in on-market offerings was less than 10%, the national distribution of counties, in terms of the number of plans participating, shifted notably between 2025 and 2026—reflecting these reductions. The number of U.S. counties with only one plan increased, as did the number with only two choices. All other categories declined. The modal number of insurers in a county for both years is three, but in 2026 the second most frequent category is two, as compared with 2025, when it was four.

Bare county risk remains low

There is always interest in the number of counties with only one insurer, since this is potentially a measure of market distress, conjuring up the prospect of a "bare" county if that remaining insurer were to exit. This was a significant threat during a prior period of instability around the years 2017-2018, when the threat of a bare county in several states was more than theoretical. 

The number of counties with just one insurer doubled between 2025 and 2026, rising from 72 to 145. While this is a significant increase, the percent of counties with only one carrier was only about five percent.

A few states saw a slight reduction in the number of counties with just one insurer. They include Alabama, Arizona, and Oklahoma. But the same time, a number of other states that didn’t have a single insurer county in 2025 gained at least one in 2026. They include Florida, Kansas, Washington, and Wisconsin. Other states that already had at least one solo-insurer county saw increases, including most notably Illinois, but also Kentucky.  Not surprisingly, the five states we previously highlighted as having the largest reduction in offerings in 2026 (Illinois, Kansas, Kentucky, Wisconsin, Wyoming) also appear in this list of states gaining one-insurer counties.

Looking Ahead: Prospects for 2027

Looking ahead to 2027, there have already been some exits announced, and the expectation is that exits may exceed entries. While it’s too soon to know exactly what participation will look like next year, if we assume the already announced exits occur and are not offset by entries, the number of counties with one carrier would increase to 202. Several new states – Connecticut, Indiana and North Carolina, would gain one-insurer counties, and Texas would increase their number of such counties from seven to 20.

The overall distribution of counties by number of insurers would also shift to reflect these announced exits. In addition to the increase in single-insurer counties, the modal category would shift from 3 insurers to 2, reflecting the overall reduction in participation. This preview of 2027 is needless to say, highly preliminary. The actual level of insurer participation may be higher, but it may also be lower.

For consumers, these exits will result in less choice and higher premiums, as remaining insurers will have more pricing power and also will be exposed to more of the risk in the market. The appeal of ICHRA to employers may be lessened if premiums rise and there is less plan choice. It remains to be seen whether the enthusiastic entry of insurers into off-exchange market will be dampened by these exits.

For the health insurance industry, the disproportionate exits by not for profit regional and provider sponsored plans accelerates longstanding trends in the individual market and is consistent with  recent patterns of exit in Medicare Advantage. Difficult market conditions favor larger firms, and are working to further consolidate the health insurance market into a small number of very large publicly traded insurers, an outcome that few would have chosen.