ACA open enrollment brings steeper premiums and fewer plan choices

WASHINGTON — People preparing to buy coverage through the Affordable Care Act marketplace should brace for notable shifts in 2027, including higher premiums and fewer plan choices.

The marketplace, also known as Obamacare, opened in most states and remains available through Jan. 15.

Among the biggest changes are expiring financial assistance, higher rates, possible delays in dealing with brokers, new limits affecting immigrants, and tighter enrollment verification.

Financial aid such as premium tax credits and cost-sharing reductions is now limited for many people who once qualified.

Health policy experts expect coverage to shrink and costs to climb. According to analysis of new CMS data by the health research nonprofit KFF, the average price of marketplace coverage is projected to rise by 13% in 2027.

Several factors are pushing prices higher

Cynthia Cox, vice president and director of the ACA program at KFF, said the increase is being driven mainly by rising medical costs, hospital consolidation and possible influences such as the No Surprises Act, which took effect in 2022 and bans surprise billing, as well as the growing use of GLP-1 drugs.

People without subsidies are expected to feel the impact most.

“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 on Friday said, “Americans using HealthCare.gov will have robust access to low-cost plans.”

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

That has contributed to 1.2 million fewer people signing up for exchange coverage.

Enrollment is trending lower

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 after enhanced subsidies were created under the American Rescue Plan Act and Inflation Reduction Act, both signed into law by President Biden.

New rules taking effect in 2027 will also cap tax credits for some lawfully present immigrants, a change that could leave another 1 million people uninsured over time.

At the same time, the Trump administration has been removing people from ACA coverage as part of its broader effort against what it calls 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 health insurance exchanges, saying the people were 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 wider crackdown on alleged fraud, would save $2.2 billion.

It remains unclear how many more people will leave ACA coverage in 2027, Cox said. But with higher premiums, changes to immigrant eligibility and 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.”