Many Affordable Care Act (ACA) insurers are proposing double-digit premium increases for 2027, seeking a median rate increase of 14% in preliminary filings with state regulators. If approved, this 14% increase would represent the second-highest increase since 2018.

Cynthia Cox, senior vice president and director of the Program on the ACA at KFF, said, "It would be a 'triple whammy' for consumers, because they have already had to pay higher premiums in 2026 and saw the expiration of more generous tax credits to offset their premiums at the end of last year."

The primary factor driving these proposed premium increases is the rising cost and use of medical care. Insurers are also noting a growing demand for costly specialty medications and weight loss drugs. Approximately 4 percentage points of the proposed premium increases are attributed to the lasting effects of the expiration of enhanced subsidies.

Enhanced subsidies enacted under President Joe Biden expired at the end of 2025. These subsidies had reduced out-of-pocket costs for consumers and contributed to an increase in ACA enrollment, which exceeded 20 million Americans. Following the expiration of these enhanced subsidies, ACA enrollment fell by approximately 3 million people by February 2026 compared to February 2025.

Insurers anticipate that a decrease in participation by young and healthy individuals will result in their remaining customer base being, on average, older, sicker, and more costly. Claims submitted on behalf of patients have also consistently been for more intense and costly levels of care. The consulting firm PwC forecast a 9% rise in the cost of caring for individuals with job-based coverage in 2027.

Premium increases will primarily impact enrollees whose incomes are just above 400% of the federal poverty level. For an individual, 400% of the federal poverty level amounts to about $62,600 this year. These individuals are no longer eligible for subsidies after the enhanced tax credits expired. People below 400% of the federal poverty level receive tax credits to help cover their monthly premiums, based on their earnings and the cost of a benchmark ACA plan. As premiums increase, the subsidies for those below this income threshold also rise, which can protect many consumers from higher prices but increases costs for the federal government.

UnitedHealthcare, in its rate filing with New York state, indicated that policy changes by the Trump administration and the expiration of larger subsidies account for 12.7% of its requested rate change. Matthew Fiedler, a senior fellow at the Brookings Institution, stated, "Depending on their particular plan's premium, they may need to switch plans to keep premiums fixed."