Millions of Americans who buy health coverage through Affordable Care Act marketplaces face a second consecutive year of double-digit premium increases, with early 2027 rate filings showing requests averaging roughly 14 percent. The jump follows a 21.7 percent spike in benchmark silver-plan premiums in 2026, and insurers including Anthem, UnitedHealthcare, and Oscar have already submitted proposed rate hikes in New York that would take effect January 1, 2027. Federal regulators say new rules will ease the pressure, but the gap between those promises and what carriers are actually requesting tells a different story.
A second straight year of double-digit ACA rate hikes
The scale of the 2027 requests is hard to dismiss. The New York regulator has published a summary of requested rate actions for the individual and small-group markets, and many of the proposed increases are in the double digits. Anthem/Empire HealthPlus, UnitedHealthcare, and Oscar are among the carriers that filed for 2027 changes, with effective dates set for January 1, 2027. New York is one of the first states to make these filings public, and the pattern there tracks with what researchers at Georgetown University’s Center on Health Insurance Reforms found in a broader review of early marketplace filings across multiple states as of mid-June 2026: marketplace premiums appear headed for a second year of double-digit growth.
That compounds the damage from 2026. The Urban Institute documented that benchmark second-lowest-cost silver plans, the plans used to calculate federal subsidies, jumped 21.7 percent in 2026. A 14 percent increase on top of that means a consumer who paid $500 a month for a benchmark plan in 2025 could be looking at roughly $690 by 2027, before subsidies. For people earning just above the subsidy threshold, that math hits hard. Even for subsidized enrollees, higher benchmark premiums can mean larger federal outlays and steeper costs for taxpayers.
Insurers point to several drivers behind the requests. Medical inflation continues to push up the prices of hospital care, physician services, and prescription drugs. Utilization has risen as people catch up on care delayed during the pandemic, and some carriers report higher spending on behavioral health and chronic conditions. Reinsurance programs in some states have helped blunt increases, but they have not been enough to offset the broader trend.
Federal rule changes and the adverse-selection risk
The Centers for Medicare and Medicaid Services released its final rule for the 2027 Notice of Benefit and Payment Parameters, which CMS said would lower costs, crack down on fraud, and expand state control. Among the measures are user fee reductions intended to put downward pressure on premiums, as well as stricter eligibility verification designed to remove enrollees who do not qualify for subsidies. The Marketplace Integrity and Affordability final rule, published in the Federal Register in June 2025, codified many of these verification and oversight changes.
The tension is straightforward. Tighter screening may reduce improper payments and help stabilize federal spending, but if enforcement pushes healthier, lower-income enrollees out of the marketplaces while sicker people remain, insurers could face a less balanced risk pool. That is the textbook recipe for adverse selection, where premiums rise because the remaining enrollees are, on average, more expensive to cover. Carriers filing 2027 rates are effectively trying to price in that uncertainty now.
Regulators counter that improved program integrity should support long-term stability. By ensuring that subsidies go only to eligible households and that enrollment data are accurate, they argue, insurers will gain more confidence in the risk profile of their members. CMS has emphasized that user fee cuts for marketplace plans are intended to offset some of the upward pressure from medical costs, and that states will have more flexibility to tailor oversight and outreach to local conditions.
What higher premiums mean for consumers
For consumers, however, the near-term reality is simple: many will see higher sticker prices during open enrollment. People who qualify for premium tax credits may be shielded from the full impact, because subsidies rise with the cost of benchmark plans. But those subsidies are tied to income, and households just over the cutoff will bear the full brunt of any increases. Small-business owners who buy coverage in the small-group market also have limited protection, especially in states that have not invested heavily in reinsurance or state-based subsidies.
Higher premiums can have ripple effects beyond monthly bills. Some enrollees respond by trading down to plans with narrower networks or higher deductibles, which can leave them with fewer provider options and more exposure if they get sick. Others may decide to drop coverage altogether, particularly younger adults who perceive themselves as healthy. That, in turn, can further erode the risk pool and feed the cycle of rising rates.
What to watch heading into 2027
New York’s filings are an early signal, not the final word. State regulators still have to review and, in many cases, trim insurers’ requests before approving 2027 rates. The extent of those reductions will vary by state, depending on local politics, the strength of actuarial review, and how aggressively officials want to push back on carriers’ assumptions. Advocates are also watching Congress, where decisions about the future of enhanced marketplace subsidies will shape how much of the premium burden falls on consumers versus the federal budget.
For now, the numbers in the early filings underscore a basic reality: even with new federal rules aimed at lowering costs and tightening oversight, the individual and small-group markets remain vulnerable to medical inflation and shifts in who signs up. Whether regulators can translate their promises into relief at the premium level will become clear as more states publish 2027 rates-and as consumers log on this fall to see what coverage will cost them in the year ahead.
