ACA Marketplace Rate Increases Projected for 2027
Health insurers participating in the Affordable Care Act (ACA) marketplace are projecting significant rate increases for 2027, with a median proposed hike of 14%, according to initial data analyzed by the health policy organization KFF. This projection follows a trend of double-digit increases, highlighting ongoing challenges in controlling healthcare costs for consumers without enhanced federal subsidies.
KFF's review encompassed 77 insurance plans across 16 states and Washington, DC, revealing that nearly half of these insurers are requesting rate adjustments between 10% and 15% for 2027 compared to 2026. Additionally, 20 plans are seeking increases exceeding 20%. Insurers face a regulatory deadline of July 15 to finalize their submissions for premium adjustments. Both federal and state regulators will evaluate these proposals before any rate changes are officially implemented.
The anticipated rate increases coincide with the removal of expanded premium tax credits in 2026, leading to higher out-of-pocket expenses for enrollees. Cynthia Cox, senior vice president and director of KFF’s ACA program, emphasized the compounded financial pressures on consumers, stating, "It's a triple hit for those without subsidies."
Insurers attributed next year's expected rate hikes to several factors, primarily the escalating costs associated with hospital services, physician care, and pharmaceuticals. The heightened use of GLP-1 anti-obesity medications and advanced drugs for complex conditions like cancer also contribute to this financial strain. Aggregate medical and prescription drug expenses surged by an estimated 10%, reflecting a significant economic burden.
Another factor affecting rates is the shift in the ACA enrollee pool. The loss of healthier individuals from the ACA in 2026, who canceled their coverage absent enhanced subsidies, has resulted in a risk pool consisting of a higher proportion of sicker individuals. Insurers predict this pattern will persist into 2027, necessitating further premium increases.
Simultaneously, changes in marketplace regulations implemented during the Trump administration have also influenced the current landscape, adding to the complexities faced by insurers in pricing their ACA plans.
As of February, about 19.2 million individuals were enrolled in ACA plans, a decrease from January 2026 figures, according to the U.S. Department of Health and Human Services. However, most Americans still rely on employer-sponsored health insurance, Medicare, or Medicaid for their coverage needs.
A report from the Georgetown Center on Health Insurance Reforms supports KFF's findings, detailing anticipated rate hikes ranging from 6.5% in Vermont to 22.4% in Washington state for 2027, based on insurer filings in nine states and Washington, DC. Sabrina Corlette, co-director of the Georgetown Center, noted that a smaller and increasingly less healthy consumer base is a primary driver of rising premiums in the ACA marketplace.