Health Insurance Premium Increases in the ACA Marketplaces

Health insurance providers participating in the Affordable Care Act (ACA) Marketplaces are proposing significant premium increases for the upcoming year.

According to recent filings by 276 insurers, a median proposed increase of 15% for 2027 has been noted. This follows on the heels of a median 18% increase request for 2026, which ultimately resulted in a 20% finalized median increase. If approved, these rate hikes mean typical premiums will have risen by over one-third in just two years, reflecting ongoing volatility and financial strain within the ACA framework.

Impact on ACA Enrollment

The proposed premium increases have coincided with declining enrollment figures in ACA plans. At the outset of 2026, about 23 million individuals chose ACA plans—a decrease of more than a million from the prior year. Compounding this, nearly 2 million more individuals terminated their coverage early in the year, contributing to a 12% enrollment decline from 2025 to 2026. This trend has been partially attributed to the expiration of enhanced premium tax credits and the increasing costs of insurance.

Shifts in Plan Selection and Deductibles

As premiums rise, many consumers have turned to higher deductible plans, such as the Bronze plans, which now encompass 40% of ACA participants up from 30% in 2025. Consequently, the selection of Silver plans—offering higher premiums but lower cost-sharing—has declined from 57% to a record-low 43%. The average ACA deductible surged over $1,000 to $3,786 in 2026. This indicates a troubling trend towards underinsurance, where the financial burden of high out-of-pocket costs may deter policyholders from seeking necessary medical care.

Challenges for Insurers and Consumers

Insurers indicate a costly risk pool as a key driver behind these premium increases, noting that risk pool changes contributed approximately four percentage points to 2026 premium hikes. They foresee a similar impact in 2027. The model requiring insurers to balance expenses with premium revenue often results in higher premiums and narrower provider networks. This balance underscores the tension between maintaining financial viability and addressing patient care needs.

• UnitedHealth Group: Requested premium hikes up to 54% in some states.
• Enrollment Impact: ACA enrollments fell 12% from 2025 to 2026.
• Average Deductible: Increased over $1,000 to $3,786 in 2026.
• Stock Buybacks: Major firms spent more than $12 billion in 2025.

Regulatory Oversight and Future Considerations

State insurance regulators are tasked with reviewing these substantial rate increase proposals before they are finalized. As the ACA faces these financial challenges, there is growing advocacy for strengthened regulatory oversight on insurer rate proposals and increased transparency regarding corporate activities, particularly significant stock buybacks. In 2025, leading health insurers collectively expended over $12 billion on stock buybacks, with UnitedHealth Group alone spending about $5.5 billion.

The increasing cost of ACA plans has sparked discussions about the potential introduction of alternative public insurance options to provide more affordable choices. Policymakers are encouraged to resolve these affordability and coverage issues to ensure that health insurance remains both accessible and financially sustainable for the broader population.