For the roughly 19 million Americans who buy their own health insurance through the Affordable Care Act (ACA) marketplaces, the shopping season for 2027 coverage opens on November 1, 2026, in most states. This year's open enrollment arrives with a long list of changes: a second consecutive year of double-digit premium increases, insurers pulling out of more than 20 states, a higher cap on out-of-pocket costs and new limits on which immigrants can receive federal subsidies [1].
Premiums are rising again
Insurers are proposing a median premium increase of 15% for 2027, according to a KFF analysis of filings from 276 insurers across all 50 states and the District of Columbia [2]. That is lower than last year, when the median proposed increase was 18% and the median finalized increase was 20%, but KFF notes it is still the second-highest requested change since 2018 [2]. Increases vary widely by state. The weighted average proposed increase ranges from under 7% in Vermont, Iowa and Utah to 29% in Arizona [1][4]. According to KFF's review of detailed filings, rising prices for medical care remain the main driver, with insurers pointing to higher costs for health services, general economic inflation and labor shortages [2]. Insurers also cite a factor unique to this market: the expiration of the enhanced premium tax credits at the end of 2025. Those expanded subsidies, first created in 2021 and extended in 2022, lapsed after Congress did not renew them. Insurers say that when subsidies shrank, healthier people were more likely to drop coverage, leaving a sicker and more expensive group of enrollees. Actuaries call this an increase in the risk pool's "morbidity" [2]. One industry review of early filings found insurers estimating that this effect added about four percentage points to premiums in 2026 and would add roughly four more in 2027 [3].
What subsidies do, and don't, cover
The headline numbers describe full-price premiums, which most marketplace enrollees do not pay. At the start of 2026, 87% of marketplace enrollees received premium subsidies, down from 92% during the previous enrollment period, largely because of the return of the so-called "subsidy cliff" [1][4]. Under the original ACA rules now back in force, households earning more than 400% of the federal poverty level, about $62,600 for a single person in 2026, do not qualify for any premium tax credit [3]. Subsidies are pegged to the price of the second-lowest-cost silver plan in each area, known as the benchmark plan. When that plan's premium rises, subsidies rise with it, which shields many lower- and middle-income enrollees from much of the increase [1]. The protection is not perfect, however. The benchmark plan's price change will not always match the change in other plans, and anyone who does not receive a subsidy, including everyone who buys coverage outside the marketplace, pays the full increase [1].
Insurers leaving, out-of-pocket limits climbing
Insurer exits outnumber new entries this year. Healthinsurance.org reports that hundreds of thousands of enrollees have plans that will end in December because their carrier is leaving the market [1]. People who do nothing will generally be moved automatically into a new plan, but consumer guides recommend choosing a replacement directly rather than relying on the automatic assignment [1]. Potential out-of-pocket costs are also rising. The most a plan can require a single person to pay in a year for covered in-network care will be $12,000 in 2027, up from $10,600 in 2026 [1]. The Department of Health and Human Services (HHS) had finalized a rule in spring 2026 that would have allowed some bronze plans to set limits as high as $15,600, but a federal court stayed that provision in July in a lawsuit brought by the City of Columbus and other plaintiffs [1]. The same court action affected catastrophic plans, which are low-premium, high-deductible policies traditionally limited to people under 30 or those with a hardship exemption. A September 2025 Trump administration rule had widened access to these plans for people who did not qualify for subsidies. With that rule now stayed, people 30 and older again need a hardship or affordability exemption to buy one [1]. About 67,500 people enrolled in catastrophic plans for 2026, and more than 20,000 of them qualified only under the expanded rule [1].
New eligibility rules for immigrants
Starting with 2027 coverage, federal marketplace subsidies will be available to only three groups of non-citizens: lawful permanent residents (green-card holders), Cuban-Haitian entrants and migrants from the Compact of Free Association nations [1]. The change comes from the 2025 budget reconciliation law, often called the One Big Beautiful Bill Act. Refugees, asylees, people with Temporary Protected Status and many visa holders who previously qualified will lose subsidy eligibility, although they may still buy coverage at full price [1]. KFF has estimated that about one million people could become uninsured by 2035 because of this provision [1].
Some states step in
A few states are adding their own assistance. Virginia is launching a "Virginia Premium Savings" program for residents with incomes between 138% and 250% of the federal poverty level. For 2027, that means an individual earning roughly $22,000 to $39,900 a year. The state subsidy will be applied automatically to metal-level plans bought through the state's marketplace [1]. Rhode Island's 2027 budget includes $19 million to partially replace the expired federal enhancements, though as of late August the state had not explained how eligibility would work [1]. Oregon is also leaving HealthCare.gov for its own state-run platform, and its roughly 106,000 marketplace enrollees will need to activate new accounts [1]. There is one modest piece of good news for people with high-deductible plans. Health savings account contribution limits will rise to $4,500 for individual coverage and $9,000 for family coverage in 2027, and all marketplace bronze and catastrophic plans remain eligible to pair with an HSA [1].
Why it matters
The debate over the enhanced subsidies was one of the defining health care fights of
2025. Supporters of letting them lapse pointed to their cost to taxpayers and the fact
that they extended help to higher-income households. Opponents warned that ending them would raise premiums and push people out of coverage. The 2027 rate filings, which cite the subsidy expiration as a contributing factor, offer an early look at how those predictions are playing out [2]. How many people re-enroll this fall will be closely watched, especially with health costs a recurring issue in the November midterm campaigns. For consumers, the practical advice across sources is consistent: read renewal notices carefully, update income information, check whether your doctors remain in network and compare plans rather than letting coverage roll over automatically [1].
Sources
- 1. Louise Norris, "2027 ACA open enrollment: What's changing," healthinsurance.org, September 2, 2026 (updated October 7, 2026). https://www.healthinsurance.org/blog/2027-aca-open-enrollment-whats-changing/
- 2. Matt McGough et al., "How Much and Why ACA Marketplace Premiums Are Going Up in 2027," KFF, August 3, 2026. https://www.kff.org/affordable-care-act/how-much-and-why-aca-marketplace-premiums-ar e-going-up-in-2027/
- 3. "2027 ACA Rate Filings: A Second Straight Double-Digit Year," Quotit, 2026. https://hub.quotit.com/blog/2027-aca-rate-filings-a-second-straight-double-digit-year
- 4. "Health insurance premium increases for 2027: Proposed rates by state and what consumers should know," healthinsurance.org, 2026. https://www.healthinsurance.org/blog/health-insurance-premium-increases-for- 2027-proposed-rates-by-state-and-what-consumers-should-know/ Information in this article is current as of October 9, 2026. Bracketed numbers refer to the sources listed above.