ACA Premiums Set for Double-Digit Jump in 2027

People preparing to enroll in Affordable Care Act health plans should expect several shifts in the coming coverage year, including double-digit premium increases and fewer plan choices.

The marketplace, commonly known as Obamacare, has been open for sign-up in most states and continues through mid-January.

Among the changes affecting the exchange are expiring financial aid, higher rates, possible delays in broker assistance, tighter rules for immigrants and stricter enrollment verification.

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

Overall, health policy experts expect less coverage and higher prices. Based on an analysis of new CMS data by the health research nonprofit KFF, the average cost of marketplace coverage is projected to climb 13% in 2027.

Several Forces Are Pushing Prices Higher

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

People who do not qualify for subsidies are likely to feel the biggest impact.

“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 on open enrollment says people using HealthCare.gov will have access to a wide range of low-cost plans.

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

That shift led to 1.2 million fewer people signing up for exchange coverage.

Nearly 20 Million People Remain Enrolled in ACA Plans

As of February, about 19.2 million people in the U.S. were actively enrolled in ACA marketplace plans, according to the Department of Health and Human Services website. Enrollment climbed during the COVID-19 pandemic after enhanced subsidies were added through the American Rescue Plan Act and the Inflation Reduction Act, both signed by Biden.

New rules taking effect in 2027 will also reduce tax credits for some lawfully present immigrants, which could leave an additional 1 million people uninsured over time.

At the same time, the Trump administration has been removing ACA enrollees from the program as part of its broader campaign 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 exchanges, saying the people were either fraudulently enrolled or did not exist.

Vance said the discovery and the cancellation of subsidy payments for hundreds of thousands of people from the exchanges, part of an administration-wide anti-fraud effort, would save $2.2 billion.

Cox said it is still unclear how many additional people will leave ACA coverage in 2027. But with higher premiums, changes to immigrant eligibility and fraud enforcement efforts, she said, “I think there's going to be fewer people enrolled in this market, but it's going to be harder to understand why.”