ACA premiums are rising sharply again as enrollment begins — are insurers responsible, or is Congress?

Brace for another dose of sticker shock as annual enrollment opens in the Affordable Care Act Marketplace.

KFF, the nonprofit health policy group, says people shopping for coverage are likely to see 2027 premiums rise by a median 15%, with participating insurers posting double-digit increases for a second straight year.

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That comes on top of a median 20% increase in 2026, bringing the two-year total to 35% — if you are fortunate. KFF says only one insurer plans to cut premiums, while many others are raising rates far more, with some increases reaching as high as 54%.

Healthinsurance.org has mapped the changes by state, with Arizona showing one of the largest increases at 27.9%.

Those higher prices are making coverage under Obamacare harder to afford for many people the law was meant to help, including retirees who are not yet eligible for Medicare.

Since the ACA was launched, the share of uninsured adults ages 50 to 64 has fallen sharply. But these double-digit premium hikes could put that progress at risk.

Here is a look at what is driving the increases, and who is most affected.

Congress, canceled policies and healthcare costs drive hikes

The ACA Marketplace is regulated federally or by states, depending on where you live, but decisions made in Washington affect the program nationwide.

When the Biden administration expanded tax credits to help subsidize ACA Marketplace premiums, enrollment climbed from 12 million people to a record 24.3 million in 2025.

Then the Trump administration ended those federal subsidies at the close of 2025, triggering a sharp jump in prices at the start of 2026, especially for middle-income Americans. That was the so-called subsidy cliff.

Some people still qualify for subsidies based on income. That includes individuals earning $15,960 to $62,600 a year, or up to $63,840 in 2027. A family with household income between $33,000 and $128,600 a year, or $132,000 in 2027, can also still receive ACA Marketplace premium subsidies.

Anyone earning above those levels is no longer eligible and must pay more for coverage. AARP estimated that 4.8 million Americans ages 50 to 64 would be hit hard. Not surprisingly, 4.6 million people have dropped their plans since June 2025.

As more people, especially younger and healthier enrollees, leave the market, the people who remain because of medical needs are left paying even higher premiums.

Healthcare costs are also continuing to climb. Insurers expect hospital care, medical services and medications — especially GLP-1 drugs — to rise 10% next year, adding to the cycle of premium increases.

As rising costs push some enrollees out, they are also leading insurers to scale back coverage for certain services and medicines, including GLP-1 drugs. Some are leaving the ACA Marketplace entirely.

According to Becker’s Payers, a health insurance trade publication, 12 major insurers, including Cigna and Providence Health Plan, will either exit the ACA Marketplace altogether in 2027 or withdraw from selected states.

Less competition is not helping hold down premiums.

How to keep health costs in check

If you already have an ACA Marketplace plan, compare options during open enrollment to see whether another provider offers a better deal. The KFF Health Insurance Marketplace Calculator can help.

You may decide to stay with your current insurer, but make sure it will still offer coverage in your state in 2027. If not, you will need to choose a new provider before the end of 2026.

Just as it helps to have an emergency fund covering three to six months of expenses, it is smart to keep extra money set aside for medical costs in a high-yield savings account.

Another option is a tax-advantaged health savings account, or HSA, which can be used for prescriptions, dental care, eye care, copays and other medical expenses. Not everyone qualifies.

It is also wise to speak with a financial advisor about the best way to protect both your money and your health, and to have a plan before facing another round of sticker shock.