Health Insurance Premium Increases in 2027 Under ACA

Millions of Americans purchasing health insurance through the Affordable Care Act (ACA) marketplace may face significant premium increases in 2027. Insurers point to rising medical costs, inflationary pressures, and federal policy shifts as driving factors behind these hikes.

An analysis of rate filings from 77 insurers across 16 states and Washington, D.C., reveals a proposed median premium increase of 14% for ACA plans, following an 18% request for 2026. These filings, submitted annually to state regulators, highlight projected healthcare cost increases as the primary catalyst for these premium changes.

Insurers anticipate a median medical cost growth of 10% for 2027, surpassing the historical average of 8%. Increased hospital charges, physician fees, and prescription drug costs are cited as major contributors to rising care expenses. Broader economic factors, including labor shortages, have also led to higher operational costs for healthcare providers, further influencing premium adjustments.

The ACA marketplace faces additional challenges with the expiration of enhanced premium tax credits, impacting enrollment rates and resulting in a sicker insurance pool with higher medical costs. Insurers also note recent federal marketplace rule changes as contributing factors.

Prescription drugs, especially GLP-1 medications for diabetes and obesity management, continue to burden expenses. Insurers report varied impacts; some manage costs by excluding weight-loss drugs, while others note increased usage of diabetes treatments. A New York insurer reported that GLP-1 medication costs have tripled recently.

Hospital system consolidations, enhancing negotiating leverage over pricing, and costs related to the federal No Surprises Act also contribute to premium increases. Premium changes requested by insurers vary widely, from approximately 1% to over 50%, with most requests between 10% and 20%. No decreases have been observed. Final rate approvals are expected later this summer.

The data stems from a Peterson-KFF Health System Tracker analysis of 2027 ACA Marketplace insurer rate filings submitted to state regulators.