The enhanced Affordable Care Act premium tax credits expired in 2026, and open enrollment for 2027 coverage begins Nov. 1 in most states without them. That brings back the old income cliff. People with incomes above 400 percent of the federal poverty level no longer qualify for premium tax credits and pay the full premium, according to KFF.
What came back with the expiration
The analysis comes from KFF, the health policy research group, in an Oct. 30 piece titled 9 Things to Watch for the 2027 ACA Open Enrollment Period. Its authors are Matt McGough, Rayna Wallace, Justin Lo, Kaye Pestaina and Cynthia Cox. They write that the enhanced credits expired in 2026 and that the 2027 period starts Nov. 1 in most states.
The cliff is the first thing that changes for a household’s budget. Under the enhanced credits, there was no income ceiling on help. Without them, a household just over the 400 percent line gets no credit at all. The line is set as a share of the federal poverty level, so the dollar figure depends on household size.
A second change reaches the tax return. Starting with tax year 2026, the budget reconciliation law eliminated the limits on how much certain enrollees must repay of excess premium tax credits. Someone who takes a credit based on an income estimate and then earns more can owe back the whole excess.
So the question for a Marketplace enrollee, before the Nov. 1 opening, is whether the 2027 premium still fits and whether income estimates are realistic. The practical move is to price 2027 coverage at HealthCare.gov or the state exchange when enrollment opens, instead of letting the current plan renew by default. A renewal notice with a higher number is the signal to shop, not to wait.
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How much premiums are rising for 2027
KFF reports that insurers proposed a median increase of 15 percent for 2027. The average finalized increase in the benchmark silver premium is 13 percent. On HealthCare.gov states the benchmark rises about 11 percent, and in states running their own marketplaces about 16 percent.
That follows a steep jump a year earlier. Benchmark premiums rose about 26 percent from 2025 to 2026, KFF says, and have risen about 42 percent on average from 2025 to 2027. Insurers estimated that changes in who stays covered added about four percentage points to 2026 premiums, and they expect a similar effect in 2027.
Which insurers are leaving
As of Oct. 29, KFF counts 11 carriers that announced plans to leave at least one state for 2027 and seven that announced plans to enter a new state. Cigna is leaving the individual market in all 11 states where it now participates.
For anyone on a Cigna plan, that makes the November window a requirement rather than a choice, because the plan itself will not be there. Other enrollees should check whether their insurer is on the exit list in their state before assuming a familiar plan will be offered.
What states and tax moves can change
Some state exchanges are filling part of the gap. KFF says New Mexico fully backfilled the lost federal help in 2026 and is continuing in 2027. California is widening its program to partly cover households at 165 to 200 percent of the poverty level, up from 138 to 165 percent. New Jersey kept its subsidy program, and Rhode Island and Virginia created new state subsidies for 2027.
The repayment change also opens a tax planning angle. KFF notes the first filings under the new rules come in early 2027. Enrollees can lower their modified adjusted gross income with HSA or traditional IRA contributions, which can raise their credits, though HSA contributions require an HSA-eligible plan.
Another rule starts in 2027. People who lose or are denied Medicaid solely because they did not meet work requirements are not eligible for premium tax credits, KFF reports.
Fewer people are in the market
The enrollment numbers show the strain. KFF says 2026 open enrollment plan selections fell by 1.2 million from 2025. Effectuated Marketplace enrollment, meaning people who paid and kept coverage, was down 12 percent, or 2.6 million, to 19.2 million by February 2026.
Enrollment in the individual market overall fell 18 percent by June 2026, from 25.2 million to 20.5 million. The Congressional Budget Office projects Marketplace enrollment will drop from a peak of 22.4 million in 2025 to 13.1 million in 2027, KFF notes.
The same KFF research arm separately reports that more than 4 million Medicare beneficiaries will have their Medicare Advantage or stand-alone drug plan terminated at the end of 2026. Health costs are shifting for older households on both sides of age 65.
What remains open for each enrollee is the number on the 2027 quote. No one outside the household can say what it will be until enrollment opens Nov. 1, and KFF’s analysis treats the credits as gone for the 2027 year.
Premium quote higher than last year’s?
A health premium that jumps for 2027 lands on a household budget that has other big bills in it. The credits that held premiums down are gone, so the savings have to come from somewhere else, and the house is usually the largest other bill.
Cut Your House Costs is an 11-page guide to ten moves on those bills. It covers “a lower home insurance bill by shopping and asking for every discount” and includes the home-cost audit worksheet, along with senior property-tax breaks and home equity options side by side.
Audit the house bills against a higher 2027 health premium with the home-cost worksheet →
This article was produced with AI assistance and edited for accuracy against the sources linked above.
