ACA Marketplace Premiums Projected to Rise by Median of 14% for 2027

Insurers participating in the Affordable Care Act (ACA) Marketplace are requesting a median premium increase of 14% for 2027, according to an analysis of preliminary rate filings from 16 states and the District of Columbia. This marks a potential second consecutive year of double-digit growth, driven by rising medical costs, the expiration of enhanced federal subsidies, and broader economic inflation.

Factors Driving 2027 Premium Requests

Health insurance providers cite three primary variables behind the proposed rate hikes. First, the underlying cost of medical care—including hospitalizations, physician services, and prescription drugs—has increased by 10% for 2027, outpacing the 8% growth observed in recent years. Specifically, the rising utilization of specialty medications, such as GLP-1 agonists, has placed significant pressure on insurer budgets.

Second, broader economic conditions continue to influence the market. Labor shortages within the healthcare sector have forced providers to raise wages, a cost that is ultimately passed on to insurers and, subsequently, to policyholders through premium adjustments.

Finally, federal regulatory changes, including adjustments to the Notice of Benefit and Payment Parameters and the Marketplace Integrity and Affordability Rule, have been identified by insurers as contributors to the upward trend in requested rates.

The Impact of Expiring Federal Subsidies

According to the Peterson-KFF Health System Tracker, this policy change resulted in a 58% average increase in out-of-pocket premiums for 2026, alongside an approximate $1,000 increase in annual deductibles per person. While many enrollees remain shielded from these costs through standard ACA subsidies, those with incomes at or above 400% of the federal poverty level—$62,600 for a single individual in 2026—lost eligibility for financial assistance entirely. This shift prompted a segment of the enrollee population to exit the Marketplace. Insurers note that the remaining risk pool is, on average, sicker and more expensive to cover. Market data suggests this “adverse selection” accounted for a four-percentage-point increase in 2026 premiums, with insurers projecting a similar impact for the 2027 plan year.

Snapshot of Rate Filings

Across the 77 insurers represented in the preliminary data, the majority have requested premium increases ranging between 10% and 20%. Notably, 20 of these insurers have submitted requests for increases exceeding 20%.

Key Statistics on Marketplace Trends

• Median Proposed Increase: 14% for 2027.
• Medical Cost Growth: 10% projected increase in underlying medical and prescription drug costs.
• Risk Pool Impact: Insurers estimate that the departure of healthier enrollees added roughly 4 percentage points to premium growth in both 2026 and 2027.
• Market Scope: Data reflects preliminary filings from 16 states and the District of Columbia.

While the current filings indicate a high-cost environment, the actual premiums paid by enrollees will continue to be heavily influenced by their eligibility for remaining federal subsidies.