Insurers selling coverage on the Affordable Care Act marketplaces have proposed a median premium increase of 15 percent for 2027, according to KFF’s analysis of rate filings from 276 insurers across all 50 states and the District of Columbia. It is the second-highest requested increase since 2018 — behind only last year’s, when insurers proposed a median of 18 percent and state regulators ultimately finalized 20. The new request lands on top of the damage already done: after Congress let the enhanced premium subsidies expire at the end of 2025, the average marketplace enrollee’s premium payment rose 58 percent this year, and roughly 3 million fewer people are paying for coverage than a year ago. Open enrollment for 2027 begins November 1 — two days before the midterm elections — which means millions of households will be looking at their new premiums in the same week they vote.
What Happened to Premiums This Year
The enhanced premium tax credits, enacted in 2021, capped what marketplace enrollees paid for coverage as a share of income and extended help to middle-income households above the ACA’s original subsidy cutoff. Congress declined to extend them, and they expired on December 31, 2025. The effect showed up immediately in what people actually pay. For those who signed up for 2026 coverage, premium payments net of tax credits rose an average of 58 percent. For an enrollee who wanted to keep the same plan they had in 2025, the average increase was 114 percent — more than double. Middle-income enrollees above the subsidy cutoff faced the full sticker price of coverage for the first time. Sign-ups fell from a record 24.3 million to 23.1 million, but the fuller measure is effectuated enrollment — people who actually paid their premiums — which dropped from 22.1 million in early 2025 to 19.2 million in February 2026. In Pennsylvania, enrollment fell 21 percent. Most marketplace enrollees still receive some subsidy under the ACA’s original structure — roughly 87 percent qualified during 2026 open enrollment — but the help is smaller, and for millions it no longer exists at all.
Why 2027 Is Climbing Again
Insurers’ 2027 filings cite rising health care prices as the primary driver — hospital costs, general inflation, and labor shortages — the same pressures pushing up employer coverage. But the filings also cite a second factor that is a direct consequence of last year’s policy choice: the people who left the marketplaces when subsidies shrank were disproportionately the healthy ones, who could most easily gamble on going uninsured. The enrollees who remained are, on average, sicker and more expensive to cover — insurers call this increased morbidity in the risk pool — and KFF’s earlier analysis attributed roughly 4 percentage points of the proposed increases to the lasting effects of the subsidy expiration. This is the mechanism health economists warned about when the subsidies lapsed: fewer healthy enrollees means higher premiums, which drives out more healthy enrollees. The 2027 filings are the first full year of that spiral showing up in the actuarial tables.
Proposed Is Not Final — Last Year It Got Worse
The 15 percent figure is what insurers have requested; state insurance regulators review and finalize rates through the fall, and the final number can move in either direction. Recent history offers a caution: for 2026, insurers proposed a median increase of 18 percent, and the finalized median came in at 20. Regulators approved more than the industry asked for, reflecting how quickly costs deteriorated as the subsidy expiration’s effects became clear. State-level filings show the range: insurers in Missouri and Kansas have proposed another round of double-digit increases, and KFF’s state-by-state data shows double-digit requests in the large majority of markets. Final 2027 rates will be locked in state by state through September and October, with the last of them landing just as open enrollment begins.
The Political Calendar
The timing is not a conspiracy; it is a statute. Open enrollment has begun on November 1 for years, and Election Day falls on November 3. But the collision is real: the first thing millions of households will do in November is see their 2027 premium, and the second is vote. The subsidy expiration was a choice made by Congress — the enhanced credits died because lawmakers declined to extend them — and the consequences have compounded on a schedule that puts the second round of increases in front of voters at the precise moment they decide who controls the next Congress. Democrats have made subsidy restoration a campaign issue; Republican leaders have shown no appetite for an extension. Whichever party wins in November will set the terms for whether the 2028 filings look like the last two years.
Where Things Stand
For the roughly 19 million people still paying for marketplace coverage, the practical sequence is: final rates through the fall, plan shopping beginning November 1, and coverage decisions due by the usual December and January deadlines. The consistent advice from consumer advocates in a year like this is to shop rather than auto-renew — the 114 percent same-plan number is the cost of staying put, and switching plans is how 2026 enrollees held their average increase to 58 percent. This is the third story in what has become a series on the reconciliation-and-expiration economy arriving in households: food assistance in July, student loans in August, and now health premiums in November. Each one lands on a date certain. The People’s Podium will follow the finalized rates as states lock them in.