ACA Marketplace insurers are proposing a median premium increase of 14% for 2027 — indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and Washington, D.C. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027, KFF researchers said.
Across the 77 ACA Marketplace insurers in the 16 states and Washington, D.C., that have submitted rate filings so far, most are requesting premium increases of between 10% and 20% for 2027 — with 20 insurers requesting premium increases of more than 20%.
States with publicly available proposed rates included in the analysis by the Peterson-KFF Health System Tracker (an online information hub dedicated to monitoring and assessing the performance of the U.S. health system) are Connecticut, the District of Columbia, Hawaii, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Minnesota, New York, Oregon, Rhode Island, Texas, Vermont, and Washington. It’s worth noting that Hawaii, Illinois, and Texas only have publicly available filings for a portion of their state’s participating insurers.
Key drivers of the premium hike, according to insurers, include the rising cost of health services, the expiration of the enhanced premium tax credits, and some federal regulatory changes.
As KFF notes, the rising cost of health services have been driven by the cost of hospitalizations, physician visits, and prescription drugs — including GLP-1s and other specialty medications. Relatedly, labor shortages and general economic inflation have driven up provider wages and costs, increasing the cost of health services, too. The underlying cost of medical care and prescription drugs has risen by 10% for 2027 — greater than the 8% average growth seen over the last few years.
The ACA’s enhanced premium tax credits expired at the end of 2025, leading to a 58% average increase in out-of-pocket premiums in 2026 and deductibles of about $1,000 more per person. Most Marketplace enrollees are largely protected from the premium increases, according to KFF, because they still qualify for ACA subsidies (though at a lower level). However, people with incomes at 400% or more of the federal poverty level ($62,600 for a single person in 2026) lost subsidies entirely when the enhanced credits expired and, therefore, face the full increase in premiums. This caused many healthier enrollees to leave the ACA Marketplaces in 2026, leaving behind a smaller number of enrollees who are somewhat sicker and more expensive to cover on average, researchers said.
Further market deterioration is expected heading into 2027, according to the report. Insurers estimate that the sicker risk pool drove 2026 premiums up by roughly four percentage points and expect another four-percentage-point increase in 2027.