ACA Premiums Rising
ACA Marketplace Premiums Projected to Soar 14% in 2027 Amid Rising Costs and Subsidy End
Key Points
Most ACA marketplace plans are requesting premium increases between 10% and 20% for 2027, with 20 insurers seeking more than 20% and 35 insurers in the 10%–15% range, according to preliminary filings analyzed by the insurers’ payer group.
Analysts note that a deteriorating healthier risk pool contributed about four percentage points to premium growth in 2026, and insurers anticipate a similar impact in 2027 as healthier enrollees drop coverage due to higher costs.
Enrollment shifts driven by subsidy expiration have already seen about 4 million Americans drop ACA coverage this year, intensifying public attention on who bears the costs as subsidies end.
Current ACA marketplace enrollment is about 19.2 million, down roughly 13% from 2025 (22.1 million) after the enhanced subsidies expired, signaling ongoing affordability and coverage challenges.
Policy analyst Matthew McGough attributes rising premiums to uncertainty in the market, saying, 'When there is so much uncertainty, insurers are raising premiums higher than they otherwise would be, and the end result is that consumers are footing a larger bill for their premiums if they’re not receiving federal tax credits.'
ACA marketplace premiums are on track for a second straight year of double-digit increases, with insurers proposing a median hike of 14% for 2027, according to KFF. If finalized, that would push premiums more than a third higher between 2025 and 2027 — a stretch of cost growth that is squeezing millions of Americans who buy their own health coverage.
The proposed increases come from preliminary filings by 77 insurers across 16 states and Washington, D.C., analyzed by KFF. Most insurers are asking for hikes between 10% and 20%. Twenty insurers are requesting more than 20%, while 35 are seeking between 10% and 15%, according to IBTimes.
Drug Costs and Inflation Push Premiums Higher
Insurers point to several forces driving costs up. Medical spending is rising broadly. Drug costs are climbing fast, led by GLP-1 weight-loss medications like Ozempic and Wegovy, as well as other specialty drugs. General inflation adds more pressure on top of that, according to KSL.
Policy analyst Matthew McGough said market uncertainty is making things worse. "When there is so much uncertainty, insurers are raising premiums higher than they otherwise would be," McGough said. "The end result is that consumers are footing a larger bill for their premiums if they're not receiving federal tax credits."
Subsidy Expiration Shifts Full Cost to Middle-Income Families
A major driver of pain for consumers is the expiration of enhanced premium subsidies at the end of 2026. Those subsidies helped millions of Americans afford coverage. Once they expire, people earning at or above 400% of the federal poverty level — roughly $60,000 a year for a single adult — lose all extra help and must pay the full premium themselves, according to AZ Mirror.
Lower-income enrollees keep some subsidy protection. But middle-income Americans are the hardest hit. Vernon Reporter notes that this group faces the full weight of rising premiums with no federal cushion to soften the blow.
4 Million Drop Coverage as Enrollment Falls 13%
The subsidy cuts are already reshaping who has coverage. About 4 million Americans have dropped ACA plans this year as costs climbed. Total enrollment has fallen from 22.1 million in 2025 to about 19.2 million today — a drop of roughly 13%, according to Juneau Independent.
The people leaving are often younger and healthier. That matters because when healthy people exit, the remaining pool of enrollees tends to be older and sicker. Analysts at KFF say this shift added about four percentage points to premium growth in 2026. They expect a similar drag in 2027 as more cost-conscious enrollees walk away.
Political Fight Over Who Caused the Cost Spike
The rising premiums are fueling a political blame game in Washington. Democrats point to the expiration of subsidies — which Congress extended under the Inflation Reduction Act but did not make permanent — as the root cause. Republicans argue the subsidies were temporary and never meant to last.
With enrollment down sharply and premiums climbing toward a one-third increase over three years, the debate over ACA affordability is intensifying heading into the 2026 election cycle. Analysts say final 2027 rates will be set later this year, leaving time for policy changes — but little sign that a fix is coming soon, according to KSL.
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