The major insurers are entering new Affordable Care Act markets as others are leaving the exchanges en masse, though in the cases of Centene and UnitedHealthcare, they paper over larger state exits.

Some major insurers in the Affordable Care Act exchanges are expanding into new counties for 2027, even as many of their peers run for the exit amid ongoing cost and policy turbulence.

Centene, the largest ACA insurer in the U.S., is expanding into 55 additional counties in Alabama, Iowa, Illinois, Louisiana, Michigan, New Jersey and Texas next year; while Oscar Health, one of the fastest-growing carriers in the exchanges, is adding 140 new counties, including by entering South Carolina for the first time.

The changes, announced in press releases Tuesday, show a continued bet on the ACA among some major participants in the exchanges, which may see a growth opportunity as their competitors downsize and leave their members looking for new carriers.

Oscar, which covers about 2.9 million ACA enrollees, is currently in the middle of a major multi-year expansion in the ACA exchanges. The company plans to add between 400 and 600 new counties by 2029, fueled by record profits in the first half of this year, executives said during an investor day last month.

In Centene’s case, the county additions paper over the company’s decision to exit two states next year as it refocuses on more profitable markets.

5 million people on the ACA exchanges, is no longer offering Marketplace plans in Delaware or New Hampshire next year.

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