If you buy your own health insurance through the ACA marketplace, 2027 is shaping up to be another expensive year. Early rate filings analyzed by the Peterson-KFF Health System Tracker show a median proposed premium increase of 14% across 77 insurers in 16 states and DC, on top of an 18% proposed increase the year before. Some insurers have proposed hikes above 50%.
This article explains what is driving the increases, who is most affected, and what you can do before Open Enrollment opens November 1, 2026.
The Numbers: 2027 Proposed Rate Increases
Among insurers with publicly available 2027 filings as of mid-2026:
- Median proposed increase: 14%
- Range: 1% to 52%
- Middle 50% of insurers: 12% to 21%
- 20 insurers proposed increases above 20%
- Zero insurers proposed a premium decrease
These are proposed rates, not final rates. State insurance regulators review and often reduce proposed increases before they take effect January 1, 2027. But even after regulatory review, significant increases are expected. In 2026, proposed rates averaged 18% and final rates came in around 20%, so the proposed figures are not ceiling estimates.
Taken together, the cumulative premium increase over 2026 and 2027 would exceed one-third for many enrollees.
What a 14% Increase Looks Like in Practice
Consider a 40-year-old in Indianapolis earning $65,000 per year, above the income threshold for enhanced premium tax credits that expired in 2026. According to Peterson-KFF data:
- 2025 (with enhanced credits): $316/month
- 2026 (credits expired): $477/month
- 2027 (projected at proposed rates): $546/month
That is a $230/month increase, $2,760 per year, in two years, driven partly by the credit expiration and partly by underlying medical cost inflation.
Five Reasons Premiums Are Rising
1. Healthcare Costs Are Growing Faster Than Usual
The underlying cost of delivering medical care, what insurers call "medical trend", is projected at 10% for 2027, above the historical average of around 8%. This reflects providers requesting higher reimbursement rates due to staffing shortages, more complex patient cases, and billing practices that have shifted post-pandemic.
2. GLP-1 Weight-Loss Drugs Are Reshaping Insurer Costs
GLP-1 medications like Ozempic and Wegovy are now widely covered on marketplace plans, and their use is growing rapidly. One large insurer reported that member utilization of GLP-1 drugs tripled from 1.6% to 5.4% of members in just two years. Per-member costs more than tripled to $49 per member per month. Another insurer projected $28.30 in additional per-member cost just from GLP-1 spending between 2025 and 2027.
Some carriers have responded by dropping weight-loss coverage for GLP-1 drugs to limit their cost exposure. Others are passing the cost through via higher premiums. Either way, this drug class is now a material driver of individual market rate increases.
3. Enhanced Tax Credits Expired, Changing Who Enrolled
Enhanced premium tax credits, enacted in 2021 and extended through 2025, expired January 1, 2026. Their expiration had two effects on premiums. First, enrollment dropped by an estimated 3 million people, many of them healthier, lower-cost enrollees who dropped coverage when premiums rose. Second, the enrollees who remained on marketplace plans skewed toward higher-cost individuals, pushing up the average claim cost for insurers. Actuaries call this a "morbidity adjustment." Insurers projected a 4% to 7.7% premium impact from this effect alone.
4. Provider Consolidation Is Limiting Competition
Hospitals and physician groups have merged at a rapid pace over the past decade. In many markets, a single hospital system now controls the majority of inpatient beds. This concentration gives providers leverage to demand higher reimbursement rates from insurers, rates that ultimately flow through to premiums. The No Surprises Act, which governs billing disputes between insurers and out-of-network providers, has added further cost; one insurer cited a 0.8% premium impact from the independent dispute resolution process alone.
5. Prescription Drug Costs Continue Rising
Beyond GLP-1 drugs, pharmaceutical costs broadly continue to outpace general inflation. Brand-name drug prices, specialty drug utilization, and the growth of high-cost biologics all contribute to the medical trend figure that drives premium increases.
Who Is Most Protected From These Increases
About 87% of 2026 marketplace enrollees received premium tax credits. Subsidies are calculated against the benchmark silver plan premium and scale upward as gross premiums rise, so subsidy-eligible enrollees are partially insulated. If your income is between 100% and 400% of the federal poverty level (roughly $15,650 to $62,600 for a single adult), you likely qualify for credits. Enhanced subsidies exist above 400% FPL under current law, though their future is uncertain.
If you qualify for subsidies, the most important action before Open Enrollment is to shop actively, not auto-renew. The benchmark plan (second-lowest-cost silver) changes each year, and your subsidy is recalculated against the new benchmark. Staying on the same plan while the benchmark shifts could leave you paying more than necessary.
What to Do Before November 1, 2026
- Do not auto-renew. Your 2026 plan's premium may have increased even before 2027 rates apply. Log in and review your options during Open Enrollment rather than accepting the default renewal.
- Estimate your 2027 income accurately. Your subsidy is based on projected income. If your income has changed from last year, update your estimate. Underestimating income means repaying excess credits at tax time; overestimating means leaving money on the table.
- Check if a lower metal tier now makes sense. If your income qualifies for Cost-Sharing Reductions (between 100% and 250% FPL), a Silver plan gives you the most value. If you are above 250% FPL and rarely use care, a Bronze plan with a higher deductible may cost less overall than a Silver plan at the new, higher rates.
- Verify your doctors are still in-network. Carriers narrow networks to control costs. Your doctor's in-network status from 2026 is not guaranteed to carry into 2027.
- Compare every carrier, not just your current one. A different carrier in your ZIP code may offer meaningfully lower premiums for the same metal tier. Only a side-by-side comparison tells you which plan is actually cheapest for your situation.
Call (713) 575-9904 to get a free comparison of all plans available in your ZIP code before Open Enrollment opens.