ACA insurers propose another round of double-digit premium hikes for 2027

Insurers selling health plans through the Patient Protection and Affordable Care Act (ACA) marketplaces are proposing a median premium increase of 14% for 2027, according to a KFF analysis of preliminary rate filings released Wednesday, July 8, putting the individual market on track for a second consecutive year of double-digit hikes.

The analysis, published on the Peterson-KFF Health System Tracker, covers 77 insurers across 16 states and the District of Columbia with publicly available filings. None proposed a decrease. Requests range from 1% to 52%, most fall between 10% and 20%, and 20 insurers are seeking increases of more than 20%.

The proposed hikes come on top of a steep climb this year. The median requested increase for 2026 was 18% nationwide, and the median finalized increase came in at 20%. If the 2027 requests hold, KFF projects, typical premiums for insurers participating in the marketplaces will have jumped by more than one-third over two years, in a market where premium growth had been relatively flat for most of the past decade. Insurers face a July 15 deadline to submit proposed 2027 premiums, and rates will be finalized in late summer.

Why are ACA premiums going up in 2027?

The largest factor is a familiar one: the price and use of care keep climbing. Insurers put medical trend, the underlying growth in the cost of hospitalizations, physician visits and prescription drugs, at 10% for 2027, up from an average of roughly 8% over the past few years, according to the analysis.

Filings repeatedly cite general economic inflation and labor shortages that have hospitals and physician groups seeking steeper reimbursement in contract negotiations. GLP-1 spending remains a persistent pressure. Several carriers that dropped weight loss coverage for the drugs told regulators that utilization for diabetes and other indications keeps climbing, and one New York insurer reported its gross GLP-1 cost per member per month more than tripled in two years.

Some filings point back at the delivery system itself. Insurers described claims growing more severe as inpatient and outpatient services are coded and billed at higher acuity, a shift KFF notes could reflect genuinely sicker patients, changes in billing practices or both.

A few carriers cited hospital consolidation, and one flagged the No Surprises Act's independent dispute resolution process, in which physicians and facilities have prevailed in most payment disputes.

Related content: The No Surprises Act's new payment dispute rule, with Anders Gilberg of MGMA

Fewer than 10% of Americans buy coverage on the individual market, but KFF notes the same cost drivers are likely to make employer-sponsored plans pricier as well.

A sicker pool and a returned subsidy cliff

The individual market's own turmoil is compounding those costs. The ACA's enhanced premium tax credits expired Dec. 31, 2025, and the fallout runs through nearly every filing KFF reviewed.

When the credits lapsed, average out-of-pocket premium payments jumped 58% for 2026 and deductibles rose by about $1,000 per person, according to KFF. Healthier enrollees dropped coverage in response, leaving behind a smaller, sicker risk pool.

Insurers estimate that dynamic pushed 2026 premiums roughly four percentage points higher than they otherwise would have been, and they are building another four-point adjustment into 2027 on top of it. Filings also cite federal regulatory changes, including the Marketplace Integrity and Affordability Rule and the late-finalized 2027 Notice of Benefit and Payment Parameters, along with coverage eligibility restrictions under H.R. 1, the budget reconciliation law enacted in July 2025 and commonly referred to as the One Big Beautiful Bill Act.

Most enrollees still receive some subsidy — 87% in 2026 — and are partly insulated from the increases. However, enrollees above 400% of the federal poverty level, which is about $62,600 for a single person in 2026, now get no help at all with the return of the ACA's original subsidy cliff.

KFF illustrates the cumulative effect with a 40-year-old in Indianapolis earning $65,000 a year: a silver plan that cost $316 per month with enhanced credits in 2025 rose to $477 in 2026 and would reach $546 in 2027 if the proposed rates are approved, an increase of $158 a month, or 41%, in two years.

Charles Miller, J.D., director of health and economic mobility policy at Texas 2036, told Medical Economics in January that the pain is real but unevenly distributed.

Of Texas' roughly 4 million marketplace enrollees last year, only about 125,000, some 3.5% of the market, earned too much to qualify for any subsidy, he said, while about 95% received help.

"While the expiration or not of those subsidies can impact a wide number of people, the extent to which the impact is felt is going to vary dramatically based on your income level," Miller said.

For households above the cliff, the swing is severe. "You have now basically lost eligibility for any subsidy, and so the premiums that you would be expected to pay for a plan on the individual marketplace could jump dramatically," Miller said. "And we're talking $10,000 or even more for that family."

What do rising ACA premiums mean for medical practices?

For practices, the disruption first arrived in January, when patients returned with changed coverage or none at all.

Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association (MGMA), said practices with marketplace-heavy payer mixes began adjusting within weeks of the credits' expiration.

"If a patient could not renew that product because their premium doubled or tripled because of the expiration of the premium tax credits, medical practices have had to think of innovative ways to help their patients, to provide payment plans, to give them discounts for cash-paying arrangements," Gilberg said on episode 122 of the Off the Chart: A Business of Medicine Podcast earlier this year.

MGMA has also urged practices to protect their own bottom line, he said, starting with insurance eligibility verification for every patient, including established ones whose coverage may have quietly lapsed at the end of 2025.

The clinical consequences concern him as much as the financial ones.

"We might have situations in which patients are no longer going in for primary care visits, and that can then cause situations in which problems that are relatively managed then become acute, and then they end up in the hospital," Gilberg said. "It's not good for our health care system to have these shocks to the system."

"I think people can decide what their position is on the subsidies and whatnot," he added, "but anytime you remove care or coverage of care from 4 million people, that can cause major problems for medical practices."

The coverage shock may also be the smaller of two. Gilberg pointed to Medicaid work requirements set to take effect closer to 2027 under the reconciliation law, with projections of more than 10 million people losing coverage. "The combination of the two is quite a lot," he said.

Stalled in Washington

Congress has had chances to change the trajectory and has not taken them. A three-year extension of the enhanced credits failed in the Senate in December, falling short of the 60-vote threshold even as four Republicans crossed the aisle.

The House passed its own three-year extension Jan. 8 on a 230-196 vote, with 17 Republicans joining Democrats, but bipartisan Senate negotiations over a shorter extension with income caps and minimum premium payments collapsed within weeks, and no deal has materialized since. Republican leaders have argued the pandemic-era credits are too costly and vulnerable to fraud, and President Trump has opposed a clean extension.

Rep. Greg Landsman (D-Ohio), a member of the House Energy and Commerce Committee's health subcommittee, told Medical Economics in late January that the enrollees losing help are often self-employed workers, farmers and small business owners.

"People go to the marketplace to get health insurance, with fewer and fewer employers providing health care for their employees, and more and more people who are working on their own, or they're farmers or small businesses," Landsman said. "But health care has gone up to such an extent that the subsidies are the only way they're able to cover the cost of health care."

He put the stakes in blunt terms: "There's going to be a big percentage of people who lose their health care. That means people will die. It's not hyperbolic, people will die."

With Congress idle, some states have moved.

Miller pointed to a policy Texas adopted in 2021, known as premium alignment, which enforces the ACA's single risk pool requirement so that plan premiums track plan generosity, pulling more federal subsidy dollars into bronze and gold plans.

"Especially as the enhanced subsidies are expiring, states have gotten very, very interested in this policy, because it does make those bronze and gold plans more affordable by bringing in more federal subsidies for those plans," he said, adding that Illinois is the largest state now exploring it.

The patients who think they can't afford coverage

Buried in the affordability crisis is a finding physicians may be positioned to act on. Before the credits expired, Texas 2036 surveyed and interviewed uninsured Texans to learn why they had not enrolled, and found that many who qualified for free or nearly free plans believed coverage was far out of reach. People eligible for free plans, or plans under $25 a month, often assumed they would have to pay $300 to $500, Miller said.

Some perceptions were simply outdated, but others ran deeper, with some respondents telling researchers that "insurance isn't for someone like me.” One person likened coverage to "a luxury handbag," something they were never going to have.

"The larger group, we think, seemed to be getting their perceptions of affordability largely from media coverage talking about premium increases and gross premium increases," Miller said. It is a caution worth keeping in mind as headlines about double-digit hikes multiply, because a proposed gross increase says little about what any individual subsidized patient will actually pay.

Even after the enhanced credits expired, Miller estimated that a little over 1 million uninsured Texans remain eligible for a free plan. Everyone in the state earning less than 200% of the federal poverty level still has access to at least one, he said, and, "perhaps paradoxically or counterintuitively, if you are eligible for subsidies, the older you are, the more likely you are to find a free plan."

For patients who walked away from the marketplace, or never looked, his message was simple: "Go take a look at this and go in with an open mind and just check it out."