Americans shopping for health insurance from today face another sharp rise in prices. Open enrollment for 2027 coverage through the Affordable Care Act marketplaces opened on 1 November, and the benchmark silver plan — the second-lowest-cost silver plan in each area, to which federal subsidies are pegged — will cost 13% more on average next year, according to an analysis by the health research group KFF, published on 30 October.
The increase follows a 26% jump from 2025 to 2026, so benchmark premiums have risen 42% over the two years combined. The rise is 11% on average in states that use the federal HealthCare.gov platform and 16% in states that run their own enrollment websites.
Insurers point to a higher-than-usual increase in the underlying cost of medical care as the main driver, KFF says, with the expiry of the enhanced premium tax credits at the end of 2025 also reshaping who signs up. KFF’s analysis of insurer filings found that changes in the risk pool added about four percentage points to premiums in 2026, with a similar additional effect expected in 2027, as healthier enrollees drop out and those remaining need more care.
Most enrollees receive a subsidy that cushions the increase, but people with incomes above 400% of the federal poverty level no longer qualify for premium tax credits and must pay the full cost — a group KFF says will be particularly hard hit. The return of the original subsidy rules also means a hard income cutoff applies again for 2027.
Enrollment is already falling. Plan selections during the 2026 open enrollment period fell by 1.2 million from 2025, and paid enrollment was down 12%, or 2.6 million people, to 19.2 million by February 2026. The Congressional Budget Office projects marketplace enrollment will fall from a peak of 22.4 million in 2025 to 13.1 million in 2027.
Choice is narrowing too: 11 insurers have announced plans to exit at least one state for 2027, against seven entering a new state, KFF reports, with Cigna leaving the individual market in all 11 states where it currently participates. Some states running their own exchanges are stepping in with state-funded subsidies — New Mexico fully replaced the lost federal assistance in 2026 and saw enrollment grow, while California is expanding its programme for 2027.
The Centers for Medicare and Medicaid Services, which runs HealthCare.gov, struck a more upbeat note in its own Plan Year 2027 fact sheet, also released on 30 October, saying more than 75% of HealthCare.gov shoppers will still have access to premiums at or below $50 a month after tax credits. It did not give an average premium change.
On HealthCare.gov, open enrollment runs from 1 November 2026 to 15 January 2027. Shoppers must enroll by 15 December for coverage starting 1 January; enrollments from 16 December to 15 January start on 1 February.
Sources: KFF, “9 Things to Watch for the 2027 ACA Open Enrollment Period” (https://www.kff.org/affordable-care-act/9-things-to-watch-for-the-2027-aca-open-enrollment-period/); Centers for Medicare & Medicaid Services, Plan Year 2027 fact sheet (30 October 2026).
