Key Takeaways
- KFF counts 11 carriers exiting the ACA Marketplaces for plan year 2027, including Cigna, which is leaving all 11 states where it sells individual plans, against 6 carriers entering new states.
- Across filings from 276 insurers, the median proposed 2027 premium increase is 15%, the second straight year of double-digit rises after a 20% median finalised increase for 2026.
- Effectuated enrollment fell from 21.8 million in February 2025 to 19.2 million in February 2026, with adults aged 18 to 34 accounting for a disproportionate share of the drop.
- Open enrollment begins November 1 in most states, and members whose plan ends can be moved into a new plan by an algorithm if they do not choose one themselves.
Most years, ACA open enrollment is a renewal season. The bulk of members roll over, marketing budgets chase a modest number of new sign-ups, and the main job is reminding people of the deadline. The 2027 season, which opens on November 1, looks different. Carriers are leaving, prices are rising for a second year in a row and a large group of members will be forced to choose a new plan whether they want to or not. For payer marketers, that turns a retention calendar into a switching market, and it does so in a sector where the usual digital acquisition toolkit carries legal risk.
A Market Losing Carriers and Members
KFF's tracker of insurer participation, updated on October 7, counts 11 carriers that have announced they will leave the Marketplaces in some or all of their states for 2027, against 6 entering new ones. The largest is Cigna, which will exit all 11 states where it currently participates, both on and off exchange, to focus on other segments. Cigna reported more than 350,000 on-exchange members in the first quarter, all of whom will need a new insurer.
The exits are spread widely. Healthinsurance.org's guide to the 2027 season reports insurers leaving in more than 20 states, with hundreds of thousands of enrollees whose plans terminate at the end of 2026, and far more exits than entries. Those members will not simply disappear. If they do nothing, the exchange can use an algorithm to place them in a replacement plan, which means the carrier that wins them may be the one that happened to match a formula rather than the one that made the best case.
The member base itself is shrinking. According to an Acuity analysis published on October 7, effectuated enrollment, which counts people who actually paid a premium, fell from 21.8 million in February 2025 to 19.2 million in February 2026. Adults aged 18 to 34 accounted for a disproportionate share of that decline. They are the healthier, cheaper members every carrier wants, and they are the group most likely to drop coverage when the price moves.
Price Is Now the Opening Message
The price is moving again. The Peterson-KFF Health System Tracker reviewed proposed 2027 rates from 276 insurers across all 50 states and DC and found a median increase of 15%, the second consecutive year of double-digit hikes after a 20% median finalised increase for 2026. Proposed changes range from a 1% cut to a 54% rise, and 51 insurers asked for more than 25%. Insurers cite a median medical trend of 10%, up from about 8% in recent years, and attribute roughly 4 percentage points to the expiry of enhanced premium tax credits and the sicker risk pool they expect as a result.
That spread is the marketing opportunity. With prices diverging so sharply between carriers in the same market, a member who renews without looking may be overpaying, and a member forced to shop by an exit will compare. Healthinsurance.org notes that 87% of Marketplace enrollees were receiving premium subsidies at the start of 2026, so the message that lands is not the sticker price but what the member will actually pay after the subsidy, which requires a personalised quote rather than a billboard number.
The calendar is also unsettled. New Jersey's Department of Banking and Insurance notes that the federal Marketplace Integrity and Affordability rule had mandated a nine-week open enrollment period for 2027, but that the change has been blocked by a legal challenge. New Jersey's own window runs from November 1 to January 31, and the state has made $5 million available for Navigator grants. Payer marketers working across state and federal exchanges need deadline messaging that is right for each market, not one national date.
The Compliance Constraint Has Not Moved
The tools most demand teams would reach for in a switching market, retargeting pixels on plan comparison pages, lookalike audiences built from site visitors and quote-form conversion tracking, are exactly the ones that create HIPAA and state privacy exposure for health plans. A member browsing a plan finder, entering a ZIP code and income, or starting an application is generating data that can identify them in a health context. Health plans are covered entities, and the scrutiny that hospital websites have faced over tracking applies to them as well.
That does not leave payers without options. It means acquisition has to be built on owned channels and consented, first-party data: email and SMS to existing members, landing pages that do not leak identifiers to ad platforms, and conversion measurement that passes through a compliant layer before reaching an ad network. It also means the creative has to work harder, because a plan that cannot follow a prospect around the web with retargeting has to win them in fewer, better impressions.
An Open Enrollment Playbook for Payer Marketers
- Map the exits in your footprint. Identify which departing carriers, Cigna included, overlap your service area and size the displaced membership before November 1, so budget follows the members who must choose.
- Lead with net price, not premium. With 87% of enrollees subsidised and proposed increases ranging from a 1% cut to a 54% rise, quote tools and messages should show what members actually pay after subsidy.
- Protect renewals before chasing switchers. Contact existing members early with their 2027 cost, because a double-digit rise is the moment a passive renewer starts comparing.
- Build creative for adults aged 18 to 34. They drove a disproportionate share of the enrollment decline, and they respond to short, plain explanations of cost and coverage rather than benefit grids.
- Audit tracking on every enrollment page. Plan finders, quote forms and application flows should send nothing identifiable to ad platforms without a compliant data layer and agreements in place.
- Localise the deadline. State exchanges such as New Jersey run to January 31 and the federal window is unsettled, so deadline messaging should be set market by market.
Open enrollment for 2027 will reward the plans that treat it as an acquisition season rather than a renewal reminder. The members are moving, the prices give them a reason to compare, and the winners will be the payers that reach them with clear numbers through channels that do not create a privacy problem along the way.
