Insurers Expand ACA Plans, Add Specialized Coverage

Insurers are making adjustments to their Affordable Care Act marketplace plans as the 2027 enrollment period approaches, with sign-ups opening November 1. Centene’s Ambetter Health will extend its reach into 55 new counties while also broadening its disease-specific coverage options next year.

These geographic expansions come alongside planned exits. Ambetter announced it will no longer participate in Delaware and New Hampshire marketplaces beginning December 31, marking the end of its 2027 coverage period in those states, according to filings from its regional affiliates.

Marketplace Changes and New Offerings

Oscar Health will launch operations in South Carolina and cover residents across 713 counties in 21 states—representing a 24% increase in available counties compared to 2026. Meanwhile, UnitedHealthcare plans to grow its footprint in Arizona, Florida, Indiana, Kansas, and Michigan, while maintaining individual marketplace plans in 29 states. However, the company will withdraw from Georgia’s exchange.

Ambetter is introducing specialized congestive heart failure programs in North Carolina and Ohio, eliminating copays for qualifying prescriptions and providing up to four annual cardiologist visits at no charge. The insurer will also roll out diabetes management plans in Louisiana, Mississippi, and Indiana, featuring zero-cost preferred insulin, related medications, supplies, and A1C testing. Additionally, Asthma and COPD plans in Georgia will cover preferred inhalers and pulmonologist visits without additional fees.

Targeted Health Plans

Ambetter Health President Katherine Kirby highlighted the success of these specialized programs, stating that they have improved patient satisfaction and primary care engagement, proving the benefits of customized healthcare approaches.

Oscar is also developing niche products. Its new RetireEase plan, available in Arizona, Florida, Ohio, South Carolina, and Texas, supports individuals transitioning from early retirement to Medicare, offering fixed costs for select services, free generic medications, and transition assistance. The company is further expanding its HelloMeno initiative to 15 states, providing menopause-related benefits such as hormone therapy, bone-density screenings, and specific medications and tests at no cost.

Oscar Health CEO Mark Bertolini emphasized that every plan is designed to empower individuals in managing their health throughout life’s stages.

Healthcare providers must now handle these shifts, as new service areas and departures affect network participation and patient transitions. Reduced out-of-pocket expenses for chronic conditions may help patients adhere to treatment plans, though exact benefits vary by provider.

The push toward condition-specific plans aligns with broader trends in Medicare Advantage, where Chronic Condition Special Needs Plans have seen increased adoption. Research from the Georgetown University McCourt School of Public Policy, published in August, documented rising enrollment in these specialized Medicare programs.

These adjustments follow recent insurer exits, including PacificSource, which announced earlier this year it would withdraw entirely from the individual market, adding to the shrinking presence of carriers under the ACA.

Financial pressures are also influencing enrollment trends. June data from state marketplaces revealed a decline in coverage following the loss of enhanced premium tax credits at the end of 2025. A KFF analysis released October 14 estimated that individual-market enrollment dropped 18%, from 25.2 million in June 2025 to 20.5 million in June 2026, encompassing both exchange and off-exchange plans.