Health insurance shoppers face a second straight year of double-digit premium increases as ACA enrollment continues

Shoppers buying their own health coverage through the Affordable Care Act marketplaces are facing a second consecutive year of steep premium increases, according to federal pricing data and a new independent analysis, as enhanced subsidies that had held costs down for three years have expired and a widening list of insurers pull back from the exchanges.

The federal government's HealthCare.gov open enrollment period for 2027 coverage began November 1 and runs through January 15, 2027, according to a fact sheet published October 30 by the Centers for Medicare & Medicaid Services. Within that window, people who buy individual coverage outside an employer are discovering that the price of a benchmark plan has climbed sharply for the second year running, on top of last year's increase.

What is driving the increases

The nonpartisan research organization KFF, in an analysis published November 6 covering plans in all 50 states and the District of Columbia, found that the average finalized "benchmark" silver-plan premium is rising 13 percent nationally for 2027. That follows a 26 percent jump in 2026, meaning benchmark premiums have risen roughly 42 percent over just two years. The increases are steeper in the 19 states that run their own marketplaces, where benchmark premiums are up 16 percent, than in the states that rely on the federal HealthCare.gov platform, where the increase averages 11 percent. KFF puts the new national average benchmark silver premium at $703 a month before any subsidy, with the cheapest available silver plan averaging $681 and the cheapest gold plan $694.

The central cause, insurers and independent analysts agree, is the expiration of enhanced federal premium tax credits at the end of 2025. Those credits, first expanded in 2021 and extended since, had capped what many households paid for coverage regardless of income and eliminated the subsidy "cliff" for people earning more than 400 percent of the federal poverty level. Congress did not renew them as part of the deal that ended a 43-day federal government shutdown last November, and a Senate vote on competing extension proposals failed in mid-December. Anyone earning above that income threshold — a single person making roughly $62,600 or a family of four earning about $128,600 — now pays the full, unsubsidized premium.

Insurers say that as healthier, often younger customers drop coverage rather than pay full price, the people who remain in the risk pool are sicker and more expensive to insure, pushing rates even higher. Analysts flagged this dynamic months ago, as the first proposed rates for 2027 became public over the summer.

"When the healthy people leave, the prices go up," said Stacey Pogue, a senior research fellow at Georgetown University's Center on Health Insurance Reforms, describing the pattern to the Associated Press in July as insurers began filing their 2027 rate requests.

Insurers retreat, enrollment falls

The pricing pressure has been accompanied by a wave of insurers scaling back their marketplace presence. KFF counted 11 carriers that had announced plans to leave at least one state's exchange for 2027 as of late October, against seven that are entering new markets. The most sweeping retreat is Cigna's: the insurer announced in April that it will exit the individual marketplace entirely in all 11 states where it currently sells plans — Arizona, Colorado, Florida, Georgia, Illinois, Indiana, Mississippi, North Carolina, Tennessee, Texas and Virginia — affecting roughly 369,000 members, a figure that had already fallen 17 percent from a year earlier as enrollment softened.

UnitedHealthcare is leaving Georgia's and Arkansas's exchanges effective January 1, after requesting a 54 percent rate increase in Georgia that the state's insurance commissioner did not fully approve; records of that filing are available through the federal CMS rate-review system. Georgia's commissioner finalized 2027 rates for the eight remaining insurers at an average approved increase of 20.7 percent for unsubsidized enrollees and projects about 54,000 fewer marketplace enrollees in the state next year, down to roughly 816,000.

Nationally, the retreat shows up in the enrollment numbers. Plan selections during the 2026 open enrollment period fell by 1.2 million compared with the prior year, and effectuated enrollment — people who actually paid their first premium — stood at 19.2 million in February 2026, a 12 percent drop. Looking at the broader individual insurance market, enrollment fell 18 percent by June 2026, from 25.2 million to 20.5 million, a loss of more than 4.6 million people. The Congressional Budget Office projects marketplace enrollment will keep sliding, from a peak of 22.4 million in 2025 to roughly 13.1 million by 2027.

Who is affected, and where help remains

The people hit hardest are those earning just above 400 percent of the federal poverty level, who received no subsidy cushion even under the old rules and now face the full rate increase with no assistance at all, as well as solidly middle-income households who lost eligibility outright when the enhanced credits lapsed. A handful of states have stepped in with their own money to soften the blow. New Mexico fully backfilled the lost federal assistance for its marketplace enrollees in 2026 and is continuing the program in 2027; its enrollment actually grew as a result. California is expanding its partial state subsidy to cover households between 165 and 200 percent of the poverty level, up from 138 to 165 percent previously. New Jersey has kept its existing state subsidy program in place, and Rhode Island and Virginia created new ones for 2027. Most states, however, have no such backstop, leaving consumers to absorb the full increase.

Separately, the Department of Health and Human Services canceled roughly 760,000 "phantom" marketplace enrollments in September as part of a fraud-prevention effort, and referred a list of about 1.2 million additional suspect enrollments to insurers for review; some of those have since been reinstated after consumers proved their eligibility.

The Trump administration has emphasized a more favorable picture of the marketplace overall. Its CMS fact sheet notes that more than 75 percent of HealthCare.gov shoppers can still find a plan priced at $50 a month or less, that subsidy-eligible enrollees can get the government to cover nearly 90 percent of the lowest-cost plan's premium — up from 85 percent in 2020 — and that shoppers have access to an average of about 100 plans and five to six insurers in their area. The agency also points to a more than tenfold increase in the number of health-savings-account-eligible plans available, after a regulatory change made most bronze and catastrophic plans HSA-compatible starting this year.

What happens next

For now, no legislative fix for the expired subsidies is before Congress, and lawmakers left Washington in December without a deal; the matter remains unresolved heading into the new year. Open enrollment continues through January 15 in states that use HealthCare.gov, though several state-run exchanges have set their own, sometimes later, deadlines. CMS has also imposed a moratorium on registering new insurance agents and brokers through February 2027 as part of a broader anti-fraud push, and 43 states plus the District of Columbia are required to implement Medicaid work requirements by January 1, 2027 — a change that could push more people toward the marketplaces, or out of coverage altogether, in the months ahead. Consumers are urged to actively compare plans rather than let coverage automatically renew, since last year's plan at last year's subsidy level may no longer be available on the same terms.