ACA Marketplace insurers filed preliminary 2027 rate requests calling for a median premium increase of 15 percent, based on filings covering 276 companies across every state and the District of Columbia. It marks a second straight year of double-digit filings, after insurers’ 2026 requests were finalized even higher than proposed, and individual 2027 requests range from one insurer’s 1 percent cut to another’s 54 percent jump. The filings are not final, but the mechanism behind them is: a Marketplace risk pool that got smaller and sicker in 2026, and insurers are now pricing next year’s premiums on top of it.
A Second Straight Year Of Double-Digit Filings
An initial round of filings from 77 insurers in 16 states and Washington, D.C. put the preliminary 2027 median at 14 percent. Once regulators in the rest of the country had filings on record, KFF’s fuller count found a median increase of 15 percent across 276 insurers in every state and the District of Columbia, with proposed changes ranging from a single 1 percent cut to a 54 percent increase and 51 insurers requesting more than 25 percent.
The 2027 proposals are lower than last year’s, but only barely: 2026’s median request was 18 percent, and state regulators finalized that year’s rates even higher, at 20 percent, once the review process concluded. If the 2027 filings hold through that same review, KFF calculates that a typical Marketplace premium will have climbed by more than one-third between 2025 and 2027 — the second-highest two-year filing since 2018, after a stretch of years when Marketplace premium growth stayed close to flat.
The dollar impact shows up in KFF’s worked example of a 40-year-old Marketplace enrollee earning $65,000 in Indianapolis who bought an Anthem silver plan: the subsidized premium was $316 a month in 2025, jumped to $477 in 2026 once the enhanced tax credit expired, and would reach $546 in 2027 if the filed rate is approved — a $158 monthly increase, or 41 percent, in two years. Enrollees near retirement age who buy coverage before qualifying for Medicare face the identical arithmetic once their own subsidy shrinks.
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The Subsidy Cliff Determines Who Feels The Full Increase
Most enrollees will not pay the full filed increase. About 87 percent of Marketplace customers received a subsidy in 2026, a share that partially insulates them from whatever a state regulator ultimately approves for 2027. That subsidy itself already shrank once this cycle: the enhanced premium tax credits, first created under the American Rescue Plan and extended through the Inflation Reduction Act, expired on December 31, 2025, cutting financial assistance across the board and pushing many enrollees toward cheaper, higher-deductible bronze plans instead of the silver coverage they previously carried.
Anyone earning at or above 400 percent of the federal poverty line — $62,600 for a single enrollee in 2026 — lost the subsidy entirely and now pays the full amount insurers file. That cliff, combined with an average 58 percent jump in after-subsidy premium payments in 2026, pushed disproportionately healthier and cheaper-to-insure customers out of the Marketplace this year, leaving a smaller enrollee base that costs more, on average, to cover.
Insurers wrote the consequence directly into their filings. Antidote Health, which sells Marketplace coverage in Texas, told regulators it built in a 6.0 percent morbidity adjustment because it expects the remaining risk pool to have higher healthcare needs as healthier consumers keep lapsing coverage. Maine Community Health Options cited a similar 4.7 percent adjustment for the same reason, and Vermont-based MVP Health Care and New York’s Kaiser Foundation Health Plan of the Mid-Atlantic States filed comparable language describing a pool that is, on paper, sicker than the one insurers priced for a year earlier.
Insurers Are Pricing Next Year For An Even Sicker Pool Than This One
This is not a one-time correction. Insurers estimate the smaller, sicker 2026 pool already pushed that year’s rates up by roughly four percentage points beyond where they otherwise would have landed, and they are now layering a second, comparable adjustment onto 2027 — projecting the same dynamic to add another four points on top of this year’s baseline. The two years compound rather than reset.
Rising medical costs are stacked on top of that structural effect. Insurers put the median underlying trend in medical care and prescription-drug costs at 10 percent for 2027, above the roughly 8 percent average recorded in each of the last several years, and they cite hospital and physician contract increases, healthcare labor shortages, and rising use of GLP-1 drugs prescribed for both diabetes and weight loss as the specific pressures behind that jump.
Some insurers also pointed to federal rulemaking that arrived late. The Department of Health and Human Services did not finalize the 2027 Notice of Benefit and Payment Parameters until May 15, 2026, after many companies had already built their rate filings, and several cited that rule alongside the separate Marketplace Integrity and Affordability Rule as adding cost or uncertainty. UnitedHealthcare of New York’s filing attributed 12.7 percent of its total requested increase directly to the combined effect of the expired tax credits and the marketplace-integrity rule.
None of this is locked in. State insurance regulators review and can trim these requests before rates take effect, and 2027 premiums will not be finalized until late summer. But the same review process approved a higher finalized rate than insurers originally proposed for 2026 — 20 percent instead of 18 percent — which cuts against any assumption that regulatory scrutiny will pull 2027’s numbers down rather than up.
One insurer’s own filing spelled out where the pattern leads without a policy reversal. Citing Congressional Budget Office estimates, Health Insurance Plan of Greater New York wrote that gross benchmark premiums are projected to keep rising in the years after 2027 if the enhanced tax credits are not restored — the same feedback loop, repeated: fewer subsidized enrollees, a costlier pool left behind, and another round of filings built on top of this year’s.
This article was researched and drafted with the assistance of artificial intelligence.
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