ACA marketplace premiums rise again as open enrollment begins without expanded subsidies

Open enrollment for next year's Affordable Care Act marketplace plans began on Nov. 1, and for the second year in a row, shoppers are confronting double-digit premium increases just as the extra federal help that cushioned costs for millions of people has disappeared. The enrollment window, which the Centers for Medicare & Medicaid Services says runs through Jan. 15 in most states, is the first since enhanced subsidies created during the pandemic expired at the end of 2025.

The combination has already reshaped the market. Insurers are raising rates, several large carriers are pulling out of states altogether, and early data suggest hundreds of thousands of people have already dropped individual-market coverage rather than pay more for it.

What is changing this year

According to a CMS fact sheet released Oct. 30, shoppers using HealthCare.gov will have an average of roughly 100 plans to choose from, offered by five to six insurers depending on their state, and more than three-quarters of buyers will be able to find a plan priced at $50 a month or less before accounting for their own health needs. The agency also says consumers who qualify for tax credits will, on average, have access to a plan where the federal government covers close to 90% of the lowest-cost premium, up from 85% in 2020.

That rosier framing sits alongside a starker set of figures from the KFF health policy research organization, which tracks rate filings in all 50 states and Washington, D.C. Its analysis of 276 insurers' filings, last updated Aug. 3, found a median proposed premium increase for 2027 of 15% — the second consecutive year of double-digit hikes, following a finalized median increase of 20% for 2026. KFF describes the request as the second-highest since 2018. Insurers point to rising health care prices, general inflation and labor shortages as the main driver, but they also cite a sicker, smaller risk pool left behind after healthier customers dropped coverage when the subsidies lapsed.

Why the subsidies disappeared

The subsidies at issue — enhanced premium tax credits that lowered or eliminated monthly premiums for many marketplace enrollees — were created under the 2021 American Rescue Plan and extended through 2025 by the 2022 Inflation Reduction Act. Congress did not act to extend them again before they expired on Dec. 31, 2025, leaving the marketplace to absorb both the loss of that assistance and the usual annual cost increases at the same time. People with incomes between 100% and 400% of the federal poverty level can still qualify for some subsidy, under the ACA's original, less generous formula, but many enrollees above that threshold — along with some below it — are now paying substantially more out of pocket.

The market has also lost some of its competition. A KFF tracker of insurer participation, updated Oct. 28, counts 11 carriers that have announced they are leaving ACA marketplaces for 2027, either entirely or in specific states, against seven carriers entering new markets. Cigna is among the departures, exiting the individual market in all 11 states where it currently sells plans. Fewer insurers in a given county generally means less competitive pricing and fewer plan options for the people who remain.

Who is feeling the squeeze

The people most exposed are the roughly tens of millions of Americans who buy coverage on their own rather than through an employer — early retirees not yet eligible for Medicare, self-employed workers, gig workers and small-business owners. Many of them do not qualify for subsidies at all, or qualify for far less than before, so a rate increase lands on them in full.

The effect on enrollment is already visible. A CMS snapshot of last year's sign-up period, posted in early December, had logged more than 5.7 million plan selections nationwide within roughly the first five weeks of that window. By the time the full year played out, a separate KFF analysis published Oct. 14 found that enrollment in the individual health insurance market — on-exchange and off-exchange combined — fell 18% between June 2025 and June 2026, from about 25.2 million people to roughly 20.5 million. KFF notes that enrollment remains well above pre-subsidy levels, up 53% from June 2019, but the trend line is now headed in the other direction, and the organization has warned that this fall's premium increases could push the market down further.

"You have to really shop around and look around and know what you're getting yourself into," said Simon Haeder, an associate professor of public health at Ohio State University, in comments reported by The National Desk ahead of this year's enrollment period.

Reaction and what comes next

Haeder described enrollees as facing a "double whammy" of rising premiums and reduced subsidy support, and predicted that healthier, better-off customers are the most likely to walk away from coverage altogether — a dynamic health economists call adverse selection, in which the people who stay enrolled skew sicker and more expensive to insure, which in turn puts upward pressure on premiums for everyone still in the pool. He urged consumers to compare plans carefully this year rather than simply re-enrolling in whatever they had, and to enroll only through HealthCare.gov or a state exchange rather than through third-party websites that have been linked to enrollment scams in past years.

For now, the practical deadlines are fixed. Consumers who want coverage to start Jan. 1 need to select or switch a plan by Dec. 15; those who enroll between Dec. 16 and Jan. 15 will see coverage begin Feb. 1. After that, most people can only enroll outside the window if they experience a qualifying life event, such as losing a job, moving or having a child, though Medicaid and the Children's Health Insurance Program remain open to new applicants year-round.

Whether Congress revisits the subsidy question remains an open question heading into the new year. No legislation to restore the enhanced credits has advanced since they lapsed, and insurers have already built their 2027 rates around the assumption that they are gone for good. Barring a late policy reversal, the dynamics now shaping this year's open enrollment — higher sticker prices, fewer insurers in some states, and a shrinking but still historically large pool of marketplace customers — are expected to persist through the Jan. 15 close of the sign-up period and into the 2027 coverage year itself.