ACA Marketplace Premiums Set for Another Double-Digit Jump in 2027: What Open Enrollment Shoppers Should Check First

Open enrollment for 2027 Affordable Care Act coverage begins on November 1 in most states, and the number shoppers will meet first is a large one. KFF, the nonpartisan health policy research group, analysed proposed 2027 rates from 276 insurers with publicly available filings across all 50 states and the District of Columbia and found a median proposed increase of 15%. That is the second consecutive year of double-digit requests. Last year insurers proposed a median increase of 18%, and the median that was ultimately finalized was 20%. KFF notes that 15% is the second-highest request since 2018, after several years in which premiums were relatively flat.

KFF identifies rising health care prices as the primary driver of the 2027 requests, as in earlier years. Insurers cite higher costs for hospital and physician services, general economic inflation and labor shortages. A second factor is the expiration of the enhanced premium tax credits at the end of 2025, which KFF links to a rise in the "morbidity" of the risk pool, meaning that the average enrollee is expected to be sicker and costlier to cover once healthier people drop out. Consumer-focused analysis from healthinsurance.org adds prescription drug costs, including GLP-1 medicines, higher utilization and federal rule changes, some of which courts have blocked from taking effect this fall.

The national median hides a very wide spread. According to healthinsurance.org's state-by-state compilation, which was last updated on September 25, proposed or approved increases run from about 3% in Vermont, 5.7% in Iowa, 6% in New York and 6.7% in Utah, to 24.4% in New Mexico, 25% in Alabama and 29% in Arizona, where the figure is still a proposal. Roughly half the states had finalized rates when that table was compiled. The gap between a proposal and the final number can be large in either direction. New York regulators approved a 6% average increase after insurers asked for 20.6%, while New Mexico's approved 24.4% landed close to the 25.6% that was requested. Anyone reading a headline figure should check whether it is a request or a decision, and which state it applies to.

For people who receive subsidies, the sticker price matters less than most headlines suggest. Premium tax credits are tied to the second-lowest-cost Silver plan in your area, known as the benchmark. You are expected to pay a set percentage of your income for that benchmark plan, and the credit covers the rest. When the benchmark premium rises, the credit rises with it. For 2027 the percentage of income that enrollees are expected to contribute runs from 2.15% to 10.22%, compared with a range of 2.1% to 9.96% in 2026. Healthinsurance.org concludes that most subsidized enrollees will see their credit offset some or all of the increase, while the full impact falls mainly on people who receive no subsidy and on those buying plans outside the Marketplace.

Last year's experience shows why the subsidy picture still matters. Healthinsurance.org reports that average net premiums paid by Marketplace enrollees rose 58% in 2026 after the enhanced subsidies expired. Average full-price premiums rose from $619 to $741 per month, and average subsidies rose from $550 to $650. The share of enrollees receiving any subsidy fell from 92% in 2025 to 87% in 2026. In other words, the credit absorbed much of the sticker increase, but the households that sat outside it, or near its edge, were exposed.

That edge is the 400% line. Subsidies end abruptly for households whose income exceeds 400% of the federal poverty level, no matter how high premiums are. For 2027 coverage, healthinsurance.org puts that threshold at $63,840 for a single person and $132,000 for a family of four in the continental United States, up from $62,600 and $128,600. Because the cutoff is a cliff rather than a slope, a household that earns slightly more than the limit can lose the entire credit. Eligibility is based on a version of modified adjusted gross income, and contributions to a health savings account or a pre-tax retirement plan reduce that figure, which is why people near the line often review their tax planning before enrolling.

A separate risk is that your insurer may not be selling your plan next year. Healthinsurance.org reports that several hundred thousand people will need to choose a new plan for 2027 because their carrier is leaving the Marketplace. If that is you, the sensible deadline to treat as real is December 31, the last day to select a plan that starts on January 1. Waiting for an automatic renewal that will not arrive could leave you uninsured for part of the year.

There are practical steps that cost nothing. First, read the renewal notice from your insurer and the Marketplace carefully, and confirm that your plan, your doctors and your prescriptions are still covered. Second, update your income estimate, because credits are calculated on projected household income and large changes during the year can lead to a repayment at tax time. Third, compare total cost rather than just the monthly premium: the deductible, the out-of-pocket maximum, the drug formulary and the provider network can matter as much as the premium if you use care regularly. Fourth, do not assume that renewing is automatically the best choice. Healthinsurance.org advises comparing plans, although it acknowledges that keeping your current plan may still come out ahead.

The larger question is what a second year of double-digit increases says about the market. Insurers are pricing for a pool that they expect to remain sicker after the subsidy changes and for care costs that keep rising faster than general inflation. If healthier people respond to higher net prices by leaving, the pool could worsen again, which would feed the next round of requests. That outcome is not certain, and KFF's data cover proposals rather than final prices, but it is the dynamic regulators and insurers will be watching as enrollment numbers come in.

A note on limits: most of the figures above are proposals or early approvals, and several states had not finalized rates when these sources were compiled. Use HealthCare.gov or your state exchange for the exact plans and prices available at your address, and treat this article as general information rather than advice about a specific purchase.