Average ACA marketplace premiums expected to rise 13% in 2027

ACA sign-ups open Sunday in most states; certain lawfully present immigrants face tax-credit limits

KFF’s analysis of new CMS data projects that the average price of health insurance purchased through ACA marketplaces will rise 13% in 2027. Healthcare experts expect higher prices and fewer coverage options as sign-ups for 2027 plans begin. Cynthia Cox, a vice president and director of the ACA program at KFF, identified rising healthcare costs and hospital market concentration as primary drivers. Cox also cited potential factors such as the No Surprises Act, which took effect in 2022 and bans surprise billing, and the rising availability of GLP-1 drugs.

The people expected to bear the sharpest increases are those who do not qualify for a subsidy. Cox said, “They may or may not be able to afford to continue to keep their coverage into next year,” adding that “a lot of them have already moved into bronze plans, which are the cheapest plans.”

New regulations starting in 2027 will limit tax-credit eligibility for certain lawfully present immigrants. The limitation is on tax-credit eligibility rather than marketplace enrollment eligibility, and could result in an additional 1 million uninsured individuals over time.

Marketplace sign-ups for ACA coverage open Sunday in most states and run through Jan. 15. Exchanges are tightening enrollment checks, and some shoppers may encounter delays in working with a broker. Financial help, including premium tax credits and cost-sharing reductions, is now restricted for many groups that were previously eligible. A CMS fact sheet about open enrollment that was distributed Friday says “Americans using HealthCare.gov will have robust access to low-cost plans.”

These changes follow the expiration of enhanced subsidies that helped offset coverage costs for most enrollees during the COVID-19 pandemic. Republicans opposed extending those subsidies during President Joe Biden’s administration, and the result was 1.2 million fewer people signing up for exchange coverage, the Associated Press reported. The price of ACA insurance had risen sharply for many people during Trump’s second term.

Marketplace enrollment grew during the pandemic after enhanced subsidies became available through the American Rescue Plan Act and Inflation Reduction Act, both signed into law by Biden. As of February, roughly 19.2 million people in the United States were actively enrolled in ACA marketplace health plans, according to the Department of Health and Human Services website.

The Trump administration has been removing ACA enrollees in what it characterizes as an ongoing campaign against waste, fraud and abuse. In September, Vice President JD Vance and other officials in the Republican administration announced plans to remove 760,000 ACA enrollees from public healthcare exchanges, alleging that some were fraudulently enrolled or did not exist.

Vance said canceled subsidy payments for hundreds of thousands of people from the exchanges would result in $2.2 billion in cost savings. He also cited the discovery of allegedly fraudulent enrollments as part of an administration-wide crackdown on fraud.

It remains unclear how many more people will drop off ACA coverage in 2027, Cox said. With higher premiums, new tax-credit limits for certain lawfully present immigrants and the administration’s anti-fraud efforts, “I think there’s going to be fewer people enrolled in this market, but it’s going to be harder to understand why,” she said.