Health insurers selling Affordable Care Act marketplace plans are asking state regulators to approve a median premium increase of 14% for 2027, according to preliminary rate filings from 77 insurers across 16 states and the District of Columbia reviewed by the Peterson-KFF Health System Tracker. The proposed increase would land on top of the roughly 20% premium jump that already took effect in 2026, after the enhanced premium tax credits created during the pandemic expired at the end of 2025. Insurers say the subsidy lapse pushed healthier enrollees out of the marketplace, leaving a smaller and sicker risk pool that is now driving costs even higher heading into next year.
The 77-Insurer Filing Behind the Proposed 14% Increase
KFF’s review covers insurers in Connecticut, the District of Columbia, Hawaii, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Minnesota, New York, Oregon, Rhode Island, Texas, Vermont, and Washington, measuring each insurer’s enrollment-weighted rate change across every metal tier it sells in a given state. Among those 77 filers, half proposed increases below 14% and half proposed more, with the middle half of filings clustered between 11% and 22%. One insurer proposed cutting its rates, while 51 insurers nationally asked for increases above 25%.
The 14% figure comes from that partial subset. Once KFF expanded its review to 276 insurers filing in all 50 states and the District of Columbia, the national median proposed increase for 2027 rose to 15%. That would mark a second straight year of double-digit hikes: insurers proposed a median 18% increase heading into 2026, and regulators ultimately approved a finalized median of 20% once that year’s review process closed. If the 2027 filings hold near their current level, typical marketplace premiums will have climbed by more than a third over just two years.
Every number in the 2027 filings is still preliminary. State insurance regulators can adjust a company’s requested rate up or down during review, and the 2026 cycle shows how far that process can move the final figure: a proposed median of 18% grew to a finalized 20% by the time open enrollment began. For a household budgeting around an unsubsidized premium, the gap between a proposed and a finalized rate can run to real monthly dollars before enrollment season even opens.
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How the Expired Premium Tax Credits Reshaped the Risk Pool
Most of the pressure insurers cite traces back to one policy change: the enhanced premium tax credits first created by the American Rescue Plan and extended through the Inflation Reduction Act expired at the end of 2025. KFF found that marketplace enrollment fell by roughly 3 million people in 2026 as the more generous subsidies disappeared, while average premium payments after subsidies rose 58% for the people who stayed enrolled.
Insurers argue the enrollees who left were disproportionately healthy, since they were the ones most likely to drop coverage once their net premium jumped. That leaves a smaller marketplace population that, on average, needs more medical care, and insurers are building that shift into next year’s rates as a morbidity adjustment. KFF estimated the effect added roughly 4 percentage points to 2026 rates, and insurers are now layering a similar adjustment onto 2027 filings built on top of that already-sicker pool.
Individual filings show how that adjustment varies by state. Antidote Health, which sells marketplace plans in Texas, built a 6.0% morbidity adjustment into its 2027 rates, while Maine Community Health Options applied 4.7% for the same reason. Both insurers pointed to the same mechanism: consumers earning at or above four times the federal poverty level lost subsidy eligibility entirely when the enhanced credits expired, and many of them are choosing to drop coverage rather than pay full price.
What Else Is Pushing 2027 Rates Higher
The subsidy lapse is not the only driver in the filings. KFF’s review found the median underlying medical trend, the year-over-year cost of medical care and prescription drugs, running at 10% for 2027, above the roughly 8% average trend insurers reported in each of the prior several years. Hospitals, physician practices, and drugmakers are pushing higher unit prices into contract negotiations, and insurers are passing those increases directly into next year’s premiums.
GLP-1 weight-loss and diabetes drugs add a smaller but growing share of the pressure. Healthfirst, a New York insurer, reported that its per-member GLP-1 drug costs more than tripled between February 2024 and February 2026, even as some competitors dropped coverage of the drugs for weight loss while keeping it for diabetes management. A separate review of the same filings found insurers split on whether that shift will help or hurt their 2027 numbers, depending on how each plan restructured its drug coverage.
Federal rule changes added a final layer of uncertainty. The Trump administration’s Marketplace Integrity and Affordability Rule and the 2027 Notice of Benefit and Payment Parameters were both cited in a handful of filings, and several insurers noted that the benefit-and-payment rule was not finalized until mid-May 2026, after some companies had already locked in their numbers. Coordinated Care Corporation, which sells plans in Washington state, flagged in its own filing that a materially different final rule could still change the accuracy of its submitted rates.
None of the 2027 numbers are final. State regulators can still negotiate individual filings down before enrollment opens, the way they trimmed some proposals during the 2026 cycle even as the overall median rose. What is already locked in is the trajectory: two consecutive years of double-digit increases, a shrinking and sicker risk pool, and nothing in the filings themselves suggesting insurers expect that pattern to reverse unless Congress revisits the subsidies it let expire.
This article was drafted with AI assistance and reviewed for accuracy against primary sourcing.
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