Courtney Mroch was already paying a high price for health insurance when she learned her insurer, Cigna, was pulling out of Tennessee’s Affordable Care Act marketplace.

The 56-year-old Nashville resident has diabetes and asthma and is a cancer survivor. She pays $1,250 a month for a silver plan this year, up from $850 a month in 2025 — more than her family’s mortgage. To keep costs down, her husband is enrolled in a separate, non-ACA plan that’s less expensive.

“Who knows who will cover me in 2027 or how much more it’ll cost,” Mroch said.

Many Americans are heading into ACA open enrollment with the likelihood of higher premiums and fewer insurance companies to choose from.…