Enrollment Challenges Rise as ACA Marketplace Premiums Increase for 2027

As open enrollment begins for health insurance under the Affordable Care Act (ACA) marketplaces for 2027, consumers face increased premiums and reduced coverage options.

Starting November 1 and running until January 15 across most states, the enrollment period follows a year of financial adjustments in these marketplaces. According to the health policy research organization, KFF, benchmark premiums are set to rise by an average of 13%, primarily due to the conclusion of enhanced federal subsidies provided during the COVID-19 pandemic. These subsidies significantly decreased costs for many, and their cessation has led to a 1.2 million drop in marketplace plan selections in 2026, indicating a growing concern about affordability.

Marketplace Challenges and Consumer Responses

The increase in premiums, along with disappearing subsidies, has pushed consumers to adjust their insurance strategies. Many individuals, now without financial assistance, are opting for more economical bronze plans, which come with higher out-of-pocket costs. Some are discontinuing coverage entirely. Cynthia Cox, KFF's Vice President and Director of its ACA program, points to rising medical costs and increased hospital market concentration as key drivers of these premium hikes.

This trend has caused a significant decline in overall enrollment, with 19.2 million people maintaining ACA marketplace coverage as of February 2026—down by 2.6 million from the previous year. Changes for 2027 will further tighten the availability of premium tax credits for some lawfully present immigrants, potentially increasing the uninsured population by an estimated 1 million by 2035, according to the Congressional Budget Office.

Regulatory Responses and Market Impacts

In response to these dynamics, the administration has intensified efforts to curb enrollment fraud. In September, actions were taken to remove approximately 760,000 individuals from ACA exchanges, which is expected to save $2.2 billion in federal spending. Despite these regulatory challenges and rising costs, officials from the Centers for Medicare and Medicaid Services maintain that affordable coverage options will remain available. However, health policy experts warn that the combination of higher premiums, reduced subsidies, and stringent eligibility criteria could lead to further declines in marketplace participation as we move into 2027.

Enrollment Statistics and Market Changes