ACA premiums set for another steep increase in 2027

Middle-income Americans buying Affordable Care Act coverage faced another premium shock for 2027, with insurers proposing a 14% median increase across 77 carriers in 16 states and the District of Columbia. The early filings point to typical ACA marketplace premiums climbing by more than one-third between 2025 and 2027.

The sharpest squeeze would fall on households that earn too much to qualify for generous help. People at or above 400% of the federal poverty level lost subsidies entirely when the enhanced tax credits expired, leaving a single adult around the $62,600 mark and a family of four at about $129,000 to absorb the full increase. Most other marketplace enrollees still receive some help through the regular ACA tax-credit system, but the middle-income band sits closest to the cliff.

Higher spending on hospitalizations, physician visits, prescription drugs, labor and inflation is pushing up the price of coverage. GLP-1 weight-loss drugs and other specialty medications are part of the pressure, and the underlying cost of medical care and prescription drugs had risen 10% for 2027, above the 8% average growth seen in recent years.

The premium outlook also reflects the loss of pandemic-era support. The enhanced premium tax credits, first created in the American Rescue Plan Act in 2021 and extended through the end of 2025 by the Inflation Reduction Act, expired at the end of last year. That expiration helped drive a 58% average increase in out-of-pocket premiums in 2026 and pushed the average ACA marketplace deductible from $2,759 in 2025 to $3,786 in 2026, a 37% jump.

The filings are still preliminary, and insurers have until July 15, 2026, to submit proposed premiums for 2027 marketplace plans. State and federal review will follow later in the summer.

Most of the 2027 requests were for increases between 10% and 20%, with 20 insurers seeking hikes above 20%, and insurers estimated that the sicker risk pool added about four percentage points to 2026 premiums and could add another four points in 2027.