ACA enrollment starts as Americans confront steeper premiums and tighter choices

The marketplace sign-up period, often called Obamacare, begins in most states and continues until Jan. 15

Open enrollment for the Affordable Care Act has started, and many Americans are facing higher prices and fewer health coverage choices.

The marketplace enrollment period opens in most states on Sunday and remains available until Jan. 15.

Health plans purchased through ACA marketplaces are projected to cost 13% more on average in 2027, according to an analysis of fresh CMS data by the healthcare research nonprofit KFF.

Beyond higher premiums and fewer plan options, people looking to enroll should also be prepared for expiring financial aid, rising rates, possible delays when working with brokers, new limits for immigrants, and tighter enrollment verification.

Financial assistance, including premium tax credits and cost-sharing reductions, is now narrower for many people who were previously eligible. Health policy experts expect reduced coverage and higher prices more broadly.

Several forces are pushing costs upward

Cynthia Cox, vice president and director of KFF’s ACA program, said the increase is largely being driven by rising healthcare costs, hospital consolidation, and possible effects from the No Surprises Act, which took effect in 2022 and restricts surprise billing, as well as the growing use of GLP-1 drugs.

Those most likely to feel the impact of the new increases are people who do not qualify for subsidies.

“They may or may not be able to afford to continue to keep their coverage into next year,” Cox said, adding that “a lot of them have already moved into bronze plans, which are the cheapest plans.”

A CMS fact sheet released in connection with open enrollment says that “Americans using HealthCare.gov will have robust access to low-cost plans.”

ACA premiums have risen sharply for many people during Trump’s second term after Republicans declined to extend COVID-era subsidies that had helped offset insurance costs for most enrollees during Democratic President Joe Biden’s administration.

As a result, 1.2 million fewer people signed up for exchange coverage.

Nearly 20 million Americans are enrolled in ACA plans

As of February, about 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.

Enrollment increased during the COVID-19 pandemic, when enhanced subsidies became available through the American Rescue Plan Act and the Inflation Reduction Act, both signed into law by Biden.

New rules taking effect in 2027 will also restrict tax credits for some lawfully present immigrants, which could eventually leave another 1 million people uninsured.

The Trump administration has also been removing ACA enrollees from the program as part of its broader effort against what it describes as 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, saying the people were either fraudulently enrolled or did not exist.

Vance said the discovery and cancellation of subsidy payments for hundreds of thousands of exchange enrollees, part of a government-wide fraud crackdown, would save $2.2 billion.

Cox said it remains unclear how many more people will leave ACA coverage in 2027.

But with higher premiums, changes to immigration eligibility and anti-fraud enforcement, “I think there’s going to be fewer people enrolled in this market, but it’s going to be harder to understand why.”