What Insurers Filed for 2027
Health insurers sellingAffordable Care Act coverage are asking for another year of double-digit premium increases, and their own filings explain why in unusually plain language.
Across 77 insurers in 16 states and the District of Columbia with publicly available filings, the median proposed increase for 2027 is 14 percent, according to an analysis by the Peterson-KFF Health System Tracker. That follows a median proposed increase of 18 percent for 2026, which finalized at 20 percent.
Two consecutive double-digit years compound. If the 2027 proposals hold, typical premiums for participating insurers will have risen by more than one-third over two years.
The spread is wide. Proposed increases range from 1 percent to 52 percent, with most falling between 10 and 20 percent. Twenty insurers requested increases above 20 percent. Not one proposed a decrease.
These are preliminary filings. State regulators review them, and rates will be finalized in late summer, so the final numbers will differ.
The Mechanism Behind the Increase
The part worth understanding is not the percentage. It is the loop the market has entered, which insurers describe openly in their filings.
Enhanced premium tax credits expired at the end of 2025. Subsidies shrank, out-of-pocket premium payments rose sharply, and people left. Marketplace enrollment fell by roughly 3 million in 2026, and average premium payments after subsidies rose 58 percent.
The people who leave in that situation are not a random sample. Someone healthy, with no prescriptions and no upcoming procedures, is more willing to gamble on going uninsured than someone managing diabetes or awaiting surgery. Insurers name this directly. Maine Community Health Options wrote that "healthier individual consumers are more likely to lapse coverage." Antidote Health, filing in Texas, said it incorporated "a morbidity adjustment of 6.0%" to account for the shift.
That leaves a smaller pool that is sicker on average and costs more per person to cover, which insurers price into next year's premiums. Higher premiums then push out more of the remaining healthier enrollees.
The size of the effect is measurable. For 2026, this dynamic was estimated to have driven rates about 4 percentage points higher than they otherwise would have been. For 2027, insurers adjusting for it project roughly another 4 percentage points, layered on top of the pool that already deteriorated.
What Else Is Driving Costs
Adverse selection is the individual-market story, but most of the increase comes from cost growth affecting all private insurance.
The median medical trend for 2027, meaning the underlying cost of medical care and prescription drugs, is 10 percent. That is up from an average of about 8 percent in recent years. Insurers attribute it to provider contract increases, general economic inflation, and health care labor shortages pushing hospitals to seek higher reimbursement.
Several filings cite rising claims severity, meaning individual claims are being billed at higher levels of complexity. One large plan reported measuring changes in how providers bill inpatient and outpatient services to increase revenue without an appreciable difference in how care is delivered.
GLP-1 medications appear repeatedly. One New York insurer reported that per-member spending on these drugs more than tripled in two years, from about $13 to $49 per member per month, while the share of adult enrollees using them rose from 1.6 percent to 5.4 percent. Some insurers dropped coverage for weight loss while keeping it for diabetes, and say that will hold 2027 increases down.
A small number cite hospital consolidation. Premera Blue Cross in Washington wrote that "limited competition and regional monopolies have reduced downward pricing pressure."
What This Looks Like for One Household
Percentages obscure what this does to a monthly budget, so the analysis includes a worked example worth repeating.
Consider a 40-year-old in Indianapolis earning $65,000 a year, enrolled in a specific Anthem silver plan. With enhanced tax credits, the monthly premium payment was $316. In 2026, after the credits expired and rates rose, it climbed to $477. If the 2027 filings are approved, it reaches $546.
That is a cumulative increase of $158 a month, or 41 percent, in two years, for the same coverage.
This household is in the group hit hardest: income just above four times the federal poverty level, which means newly ineligible for subsidies once the enhanced credits lapsed. Below that threshold, subsidies still absorb much of the increase.
Most enrollees remain subsidized, 87 percent in 2026, and are partially insulated depending on the plan they pick. But a smaller share receives help than before, and many have shifted into bronze plans with substantially higher deductibles to keep premiums manageable. MedicalDaily has reported on that shift toward bronze plans and record deductibles, which is the other half of this affordability picture.
What Enrollees Can Do Before Open Enrollment
Nothing changes coverage today, and the useful preparation is a few weeks off.
Open enrollment for 2027 is expected in November. The single most valuable habit is not auto-renewing. Plans change, and the benchmark plan that sets subsidy amounts can change beneath you, so a plan that was well priced this year may not be next year. Compare options rather than letting the current one roll over.
Check the deductible and the out-of-pocket maximum alongside the premium. A cheaper bronze plan can cost more overall for anyone with regular prescriptions or a chronic condition, and the lowest premium is frequently not the lowest total cost.
Verify that your medications are on the formulary and your clinicians are in network for the specific plan you select, not the plan family. If you take a GLP-1, check specifically whether the plan covers it and for which indication, since several insurers changed those rules.
Anyone whose income estimate has shifted should update it at healthcare.gov, since subsidies are calculated from projected income and errors are reconciled at tax time.
Whether Congress restores enhanced credits before November would change this picture substantially, and that remains unresolved.
The confirmed fact is a median proposed increase of 14 percent for 2027, a second consecutive double-digit year. Those most affected are enrollees just above the subsidy threshold and people with chronic conditions in high-deductible plans. The reasonable action is comparing plans at open enrollment rather than auto-renewing. The central uncertainty is whether Congress acts on premium tax credits. The next expected development is final approved rates in late summer.
Frequently Asked Questions
How much are 2027 premiums going up? The median proposed increase is 14 percent across 77 insurers in 16 states and DC. Proposals range from 1 percent to 52 percent.
Are these final? No. State regulators review filings and rates are finalized in late summer. Last year's median proposal of 18 percent finalized at 20 percent.
What does a sicker risk pool mean? Healthier people were more likely to drop coverage when subsidies shrank, leaving an enrollee base that costs more per person to cover.
How much of the increase is from that? Insurers adjusting for it project roughly 4 percentage points for 2027, on top of a similar 4-point effect already built into 2026 rates.
What is driving the rest? Medical trend of about 10 percent, reflecting provider contract increases, inflation, labor shortages, higher-severity billing and GLP-1 spending.
Will my premium go up by 14 percent? Not necessarily. Increases vary by insurer, state and plan, and most enrollees receive subsidies that absorb part of the change.
What should I do before open enrollment? Compare plans rather than auto-renewing, check deductibles and out-of-pocket maximums, and confirm your drugs and doctors are covered.
