As roughly a dozen insurers flee the ACA exchanges ahead of 2027, Centene, Oscar Health, and UnitedHealthcare are quietly expanding into new counties. Oscar is growing its footprint by 24%, while Centene is rolling out condition-specific plans for heart failure, diabetes, and asthma. The moves come as premiums are set to jump a median 15% — the steepest back-to-back increase since 2018.
The ACA marketplace is heading into 2027 in turbulent shape — but not everyone is pulling back. While roughly a dozen insurers, including Cigna, Molina, and CareSource, are exiting the exchanges in some or all states, Centene, Oscar Health, and UnitedHealthcare are expanding their county footprints, betting that competitors' departures create a growth opportunity.
Oscar Health is making the boldest move, growing its county presence by 24% to 713 counties across 21 states. The company is launching new products like RetireEase — a plan designed to bridge early retirement to Medicare — and expanding its menopause-focused HelloMeno plan to 15 states. Centene, the largest ACA insurer, is adding 55 counties while simultaneously exiting Delaware and New Hampshire, making it a net wash. It's also rolling out condition-specific plans targeting congestive heart failure, diabetes, and asthma/COPD, with $0 copays for key medications and specialist visits.
The backdrop is challenging: enhanced ACA subsidies expired at the end of 2025, causing enrollment to drop by more than 4.6 million people and leaving a smaller, sicker risk pool.
By the Numbers:
Why it matters: Millions of Americans who relied on departing insurers will need to find new coverage — and quickly. The remaining players are reshaping what ACA plans look like, leaning into personalization and condition-specific benefits to attract and retain members in an increasingly costly market.
