Health insurance through the Affordable Care Act (ACA) marketplace is about to get significantly more expensive in 2027 — and for many Americans, this is the second consecutive year of painful premium hikes.

After the enhanced subsidies that had kept millions of people’s premiums low expired at the end of 2025, ACA marketplace costs surged in 2026. Now, preliminary rate filings show insurers are proposing another round of double-digit increases for 2027. If you buy your own health coverage, understanding what’s happening — and why — could save you hundreds of dollars this year.

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A Quick Recap: What Happened to the Enhanced Subsidies?

From 2021 through 2025, millions of Americans benefited from enhanced Premium Tax Credits (PTCs) — extra financial help that dramatically reduced monthly insurance costs. These were introduced by the American Rescue Plan Act (ARPA) in 2021 and extended through the Inflation Reduction Act (IRA) in 2022.

At their peak, the enhanced subsidies helped push ACA enrollment to a record 21.4 million people in 2024, with many qualifying for plans as low as $0 per month.

But those enhanced subsidies expired on December 31, 2025, and Congress did not renew them. The result has been immediate and widespread: premiums jumped approximately 20% in 2026 for many marketplace enrollees — and 2027 is shaping up to be just as difficult.

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How Much Will ACA Premiums Go Up in 2027?

According to a Peterson-KFF Health System Tracker analysis of rate filings from 276 insurers across all 50 states and Washington, D.C., the median proposed premium increase for 2027 is 15%.

To put that in perspective:

• About 63% of insurers are proposing increases between 10% and 25%
• Some insurers are requesting increases as high as 54%
• Only a small number of plans proposed any decrease at all (as low as -1%)

A separate KFF analysis of 77 insurers across 16 states found a similar median increase of 14% for 2027.

Combined with 2026’s increases, ACA marketplace premiums could rise by more than one-third between 2025 and 2027.

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Why Are Premiums Skyrocketing?

Several factors are driving costs up simultaneously:

1. The Subsidy Expiration Changed Who’s in the Pool

When enhanced subsidies expired, healthier — and typically younger — enrollees who had signed up largely for the financial benefit dropped their coverage. The people who stayed tend to use more medical care. Insurers project this “risk pool deterioration” alone will add about 4 percentage points to 2027 premiums.

2. Medical Costs Are Rising Faster Than Usual

The underlying growth rate for medical care and prescription drugs is running at 10% for 2027, above the historical average of 8%. Hospitalizations, physician visits, and lab costs have all climbed.

3. GLP-1 Weight-Loss and Diabetes Drugs

These blockbuster medications — think Ozempic and Wegovy — are among the fastest-growing insurance expenses. One New York insurer reported that GLP-1 drug costs more than tripled over two years, rising from $13 to $49 per member per month.

4. Healthcare Labor Shortages

Hospitals and medical facilities continue to face staffing challenges, pushing up provider wages and the rates they charge insurers.

5. Provider Consolidation

Hospital mergers in many markets have reduced competition, giving health systems more leverage to demand higher reimbursements from insurance companies.

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Who Is Hit Hardest?

Not everyone faces the same impact. Here’s how the burden breaks down:

People earning above 400% of the Federal Poverty Level (FPL) — roughly $62,600 or more per year for a single person in 2026 — lost all marketplace subsidy eligibility when the enhanced credits expired. They now face the full cost of their premium with no government assistance.

Adults aged 50–64 are particularly exposed. Because premiums scale with age, older marketplace enrollees already paid higher base rates — and are now absorbing large increases without the cushion of enhanced subsidies.

Self-employed individuals, gig workers, and early retirees who rely on marketplace coverage rather than employer-sponsored insurance have no employer contribution to soften the blow.

By contrast, lower-income enrollees (those earning below 250% FPL) still qualify for cost-sharing reductions and baseline premium tax credits, so their exposure is more limited — though not zero.

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What Are Your Options for 2027?

Even in a difficult environment, there are practical steps you can take during Open Enrollment (November 1 – January 15):

1. Reassess your plan tier. If you’re currently on a Gold plan, switching to a Silver or Bronze plan may significantly reduce your monthly premium — especially if you’re relatively healthy and willing to accept a higher deductible.

2. Check if your income qualifies you for any subsidy. Even with the expiration of enhanced credits, baseline ACA subsidies still exist for lower and middle incomes. Use the calculator at Healthcare.gov to see exactly what you qualify for before assuming you owe full price.

3. Explore a Health Savings Account (HSA). Pairing a high-deductible health plan with an HSA lets you save pre-tax dollars for medical expenses — reducing your effective out-of-pocket cost even when premiums are high.

4. Compare every available plan in your area. Proposed rates vary dramatically by insurer — some are proposing increases of just a few percent while others are requesting over 50%. The cheapest plan in your area in 2026 might not be the cheapest in 2027.

5. Consider Medicaid if your income dropped. If your household income fell significantly, you might qualify for Medicaid, which has no premiums. Eligibility rules vary by state.

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Will Congress Step In?

As of mid-2026, there is no legislation in Congress to restore enhanced ACA subsidies or cap premium growth for 2027. Some lawmakers have proposed measures, but none have advanced. Until the political landscape shifts, marketplace enrollees should plan around the current rules.

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The Bottom Line

ACA marketplace premiums are on track to be dramatically higher in 2027 than just two years ago. The combination of expired enhanced subsidies, medical cost inflation, and an aging enrollment pool has put significant financial pressure on anyone who buys their own health insurance.

The most important thing you can do: don’t let your current plan auto-renew without comparing options. Use Open Enrollment to shop carefully, check your subsidy eligibility, and find the plan that gives you the best value in a year where every dollar counts.

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Sources: Peterson-KFF Health System Tracker, KFF Health Policy Research, Centers for Medicare & Medicaid Services (CMS), Healthcare.gov