Roughly 20 health insurers that sell Affordable Care Act Marketplace plans asked state regulators for 2027 premium increases topping 20 percent, part of a wider round of filings that mostly proposed double-digit hikes for the second year in a row. The requests were among the earliest signals of what marketplace shoppers can expect to pay when the next open enrollment period begins November 1. States review and finalize those numbers before plans go on sale, so the requested figures are not guaranteed to be the ones that show up on a household’s bill.
Why Roughly 20 Insurers Asked for More Than 20 Percent
The tally comes from an analysis of preliminary rate filings submitted by 77 ACA Marketplace insurers across 16 states and Washington, D.C., the first wave of data available before every state’s filings are public. Most insurers in that group requested increases between 10 and 20 percent, but 20 of them asked for more than 20 percent, and the median proposed increase across the group came in at 14 percent.
That is on top of an already steep climb. According to KFF’s analysis of the preliminary filings, this marks the second consecutive year of double-digit median increases, and if the proposed 2027 numbers hold, typical premiums for marketplace insurers will have jumped by more than one-third over just two years.
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The Three Forces Insurers Say Are Driving Costs Higher
Insurers pointed to a handful of recurring reasons in their filings. The underlying cost of medical care and prescription drugs rose an estimated 10 percent heading into 2027, above the roughly 8 percent average of recent years, driven by hospital and physician costs, GLP-1 weight-loss and diabetes drugs, and general labor shortages pushing up provider wages. Some insurers said they are dropping coverage of GLP-1 drugs for weight loss while keeping it for diabetes management, which they expect to soften costs somewhat; others said rising diabetic GLP-1 use will keep pushing spending up regardless.
Federal regulatory changes, including a new Notice of Benefit and Payment Parameters and the Marketplace Integrity and Affordability Rule, were also cited as adding upward pressure, though insurers generally described that effect as smaller than the medical-cost trend. A handful of filings also referenced provisions of last year’s federal tax and spending law, mainly around new enrollment verification rules that insurers say will shift who ends up in their risk pool.
How the End of Enhanced Tax Credits Reshaped the Risk Pool
The biggest ACA-specific factor was the expiration of enhanced premium tax credits at the end of 2025. That change pushed unsubsidized out-of-pocket premiums up an average of 58 percent in 2026 for enrollees who lost the extra assistance, and it pushed some healthier people out of the marketplace altogether because they no longer found coverage affordable without it. Insurers say that has left a smaller, somewhat sicker pool of remaining enrollees, a dynamic detailed in a companion Peterson-KFF Health System Tracker analysis of the same filings, which estimates that shift alone is adding roughly four percentage points to premiums for a second straight year as insurers price in an enrollee base they expect to keep getting costlier.
People with incomes at or above four times the federal poverty level, who lost subsidy eligibility entirely when the enhanced credits expired, are the ones most exposed to the full sticker price of these increases. Most other marketplace enrollees still qualify for some subsidy, which cushions at least part of any approved increase.
What Happens Between a Preliminary Filing and a Final Rate
A preliminary filing is a starting point, not a final bill. State insurance regulators review each insurer’s assumptions, can push back on parts of the proposed increase, and ultimately approve a final rate that may land above or below what was originally requested. Open enrollment for 2027 marketplace coverage begins November 1, 2026, which sets the practical outer deadline for that review process, since approved rates need to be loaded into the marketplace before shoppers can compare and enroll in plans. Final numbers for most states typically land in the weeks leading up to that date rather than all at once.
What This Means for a Household Comparing Plans This Fall
None of this means every marketplace enrollee is about to see their premium jump 20 percent or more. The 20 insurers asking for the steepest increases are a subset of a subset, drawn from the states with public filings so far, and most of the broader field proposed changes well under that threshold. But the direction is consistent across nearly every filing reviewed: healthcare costs, drug prices and a smaller, pricier risk pool are all pushing 2027 rates up, and the size of the final increase a given household actually sees will depend on their insurer, their state’s rate review, and how much of it their subsidy still absorbs once open enrollment opens on November 1.
Because the final, state-approved rate can differ from what an insurer originally requested, the only way to know an exact 2027 premium is to compare plans once open enrollment opens rather than relying on a preliminary filing number. Enrollees who are close to the income cutoff for subsidies have the most reason to check every year, since a small change in income or household size can shift how much of any approved increase they actually end up paying.
This article was produced with AI assistance and reviewed by a human editor. Figures are linked to their primary sources; where a claim could not be verified from the public record, we say so.
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