Fifty-one health insurers have asked state regulators for 2027 marketplace premium increases of more than 25 percent, according to an updated analysis that now covers every state.
The Peterson-KFF Health System Tracker reviewed 276 Affordable Care Act marketplace insurers across all 50 states and the District of Columbia. Proposed changes range from a 1 percent decrease to a 54 percent increase, and 63 percent of proposals fall between 10 and 25 percent. The median request is 15 percent. One insurer proposed lowering premiums.
For households, the number that matters is not the median. It is whether your specific insurer sits in that top group, because a family's premium is set by one plan in one state, not by a national average. The people who feel the full increase are a specific group: those earning above four times the federal poverty level, who lost subsidies entirely when the enhanced premium tax credits expired at the end of 2025.
The Arithmetic Over Two Years Is Steeper Than One Year Suggests
Two consecutive years of increases compound in a way a single headline percentage hides.
If the proposed rates hold, KFF projects that typical premiums for participating marketplace insurers will have jumped by more than one third over a two-year period. Last year's median proposed change was 18 percent, and the median finalized change was 20 percent, a reminder that final rates have recently landed above proposals.
KFF illustrated the effect with a 40-year-old in Indianapolis earning $65,000 on an Anthem silver plan. The monthly payment was $316 with enhanced credits, rose to $477 in 2026 as they expired, and would reach $546 in 2027 if the proposed rates are approved. That is $158 more a month, or 41 percent, in two years.
Most enrollees are partly insulated. Roughly 87 percent of 2026 marketplace enrollees received a premium subsidy, and because subsidies are tied to the cost of a benchmark plan, they rise as premiums rise. That protection is real but conditional. KFF notes that subsidized enrollees may be insulated depending on the plan they select, and that reduced assistance has already pushed people toward lower premium bronze plans that tend to carry higher deductibles.
Insurers and Critics Point to Different Parts of the Same Filings
The disagreement over cause is worth presenting as a disagreement, because both explanations appear in the documents.
Insurers cite three drivers in their filings: the rising underlying cost of medical care and prescription drugs, the expiration of the enhanced premium tax credits, and federal regulatory changes. The median change in the underlying cost of medical care and prescription drugs was 10 percent for 2027, above the 8 percent average of recent years. One New York filing quoted in the analysis attributes 12.7 percent of its requested rate change to the combination of the subsidy expiration and a CMS marketplace integrity and affordability rule.
Critics emphasize the policy chain. When enhanced credits lapsed, out-of-pocket premiums rose an average of 58 percent for 2026, and deductibles climbed roughly $1,000 per person. Healthier enrollees left the marketplaces, leaving a smaller and, on average, sicker risk pool. Insurers adjusting for that effect project it will drive 2027 premiums up by roughly 4 percentage points beyond what they otherwise would have been, on top of a similar 4-point effect already built into 2026.
Both accounts describe the same mechanism from different ends. Rising medical prices remain the largest single driver, as they were before the subsidies expired. The subsidy expiration is layered on top through the composition of who remains enrolled.
Cynthia Cox, senior vice president and director of KFF's program on the ACA, told KFF Health News the situation amounts to a "triple whammy" for consumers, because households already absorbed higher premiums in 2026 and lost the more generous credits at the end of the prior year.
Enrollment Has Already Fallen, Which Feeds the Next Cycle
The sharpest exposure falls on households just above the 400 percent threshold, which was $62,600 for a single person in 2026, since a few hundred dollars over that line means no credit at all.
Effectuated marketplace enrollment fell from 21.8 million to 19.2 million, and it declined in every state except New Mexico, the only state that fully replaced the expired federal credits with state-funded subsidies. New Mexico instead grew 14 percent. States running their own platforms saw an average 6 percent decline against 15 percent for states on HealthCare.gov, and the national effectuation rate fell from 90 percent to 83 percent. The drop followed six consecutive years of growth.
That matters clinically, not just financially. People who drop coverage tend to defer preventive care, delay filling prescriptions for chronic conditions, and present later with more advanced disease. Households managing diabetes, hypertension, asthma, or cancer follow-up are the ones for whom a coverage gap converts most directly into a health outcome.
Steps Worth Taking Before Open Enrollment
These are preliminary filings. They may change during state rate review, and 2027 rates will be finalized in late summer. Nobody should make a coverage decision on a proposed number.
The practical steps are ordinary and time-sensitive. Open enrollment for 2027 coverage begins in the fall, and the single most useful action is to actively compare plans rather than allow automatic re-enrollment. Because subsidies are pegged to a benchmark plan, staying in the same plan can mean paying more even when a comparable option would cost less.
Households should check their projected income carefully, since eligibility turns on it, and should confirm that their current physicians and prescriptions remain in network and on formulary before switching. State insurance departments publish approved rates and often run consumer assistance lines. Certified navigators and brokers can help at no cost.
Anyone who loses coverage should ask a clinician's office about sliding-scale fees and check eligibility for Medicaid or the Children's Health Insurance Program, which have separate income rules and enroll year-round. Do not stop taking a prescribed medication because of cost without first speaking with a clinician or pharmacist, who can often identify generic alternatives or patient-assistance programs.
What remains unknown is how much Congress may act on the expired credits before 2027 coverage begins, how many of the outlier requests survive rate review, and how far enrollment falls next year. MedicalDaily will track the finalized rates when states publish them.
Frequently Asked Questions
How many insurers asked for more than 25 percent? Fifty-one, out of 276 marketplace insurers reviewed across all states and DC.
What is the typical request? A median increase of 15 percent, with 63 percent of proposals between 10 and 25 percent.
Are these final? No. Filings are preliminary and may change in state rate review. Rates are finalized in late summer.
Will everyone pay the full increase? No. People below 400 percent of the federal poverty level still receive subsidies that rise with premiums, though the degree of protection depends on the plan chosen. Those above that line lost subsidies entirely.
Why did premiums jump in 2026? The ACA's enhanced premium tax credits expired at the end of 2025, raising out-of-pocket premiums an average of 58 percent.
What do insurers say is driving 2027 increases? Rising medical and drug costs, the subsidy expiration, and federal regulatory changes.
What should I do now? Compare plans actively during open enrollment rather than auto-renewing, and verify your income estimate, network, and formulary.
