ACA Insurers Have Asked for a Median 15% Increase for 2027. About Four Points of It Is the Subsidy Expiry.
Rate filings from 276 insurers in all 50 states and DC show a second straight year of double-digit proposals, with medical trend and a sicker risk pool doing most of the work.
The short answer
- Across 276 insurers in all 50 states and the District of Columbia, the median proposed 2027 ACA Marketplace premium increase is 15%, according to a Peterson-KFF analysis of rate filings submitted to state regulators.
- Proposals range from −1% to 54%; 63% fall between 10% and 25%, with the 25th percentile at 11% and the 75th at 22%. Fifty-one insurers proposed more than 25%.
- Among 77 insurers in 16 states and DC that itemised their assumptions, the median medical trend was 10%, with roughly 4 percentage points attributed to a deteriorating risk pool after enhanced premium tax credits expired at the end of 2025.
- Separately, the CMS 2027 Notice of Benefit and Payment Parameters final rule, issued May 15, 2026, cut exchange user fees to 1.9% of monthly premiums on the federal exchange and 1.5% on state exchanges using the federal platform.
Health insurers selling on the Affordable Care Act marketplaces have filed their proposed rates for 2027, and the middle of the distribution is a 15% increase. That is the second consecutive year of double-digit proposals.
The shape of the filings
Peterson-KFF reviewed filings from 276 insurers covering all 50 states and the District of Columbia. The spread matters as much as the median.
- Median proposed increase: 15%.
- Full range: −1% at the low end to 54% at the high end.
- 63% of insurers proposed increases between 10% and 25%.
- 25th percentile: 11%. 75th percentile: 22%.
- 51 insurers proposed increases above 25%.
One insurer proposed a small decrease. The bulk of the market clustered in a band a little above ten percent, and the tail above 25% is not trivial.
What insurers say is driving it
A subset — 77 insurers in 16 states plus DC — set out their assumptions in enough detail to be itemised. Two components dominate.
- Medical trend: median 10%, covering higher healthcare prices, higher utilisation, and negotiated increases in provider contracts.
- Risk pool morbidity: roughly 4 percentage points, attributed to healthier enrollees leaving the market after enhanced premium tax credits expired at the end of 2025.
The second of those is the one with a policy fingerprint on it. When a subsidy that lowered premiums goes away, the people most likely to drop coverage are the ones who were using it least. What remains is a smaller, sicker pool, and its average cost per member is higher. Insurers are pricing for that.
Beyond the two headline drivers, filings cited general inflation on supply chains and provider costs, healthcare labour shortages pushing wages up, rising claim severity through higher-acuity billing, GLP-1 medication utilisation (with mixed effect — some insurers dropped weight-loss coverage), provider consolidation reducing competitive pressure on prices, and federal regulatory uncertainty.
What the rules already fixed
Some 2027 parameters are settled. The CMS Notice of Benefit and Payment Parameters for 2027, issued May 15, 2026 and effective July 20, 2026, set the user fees insurers pay to operate on the exchanges — a component of premium that moved the other way.
- Federally facilitated exchange user fee: 1.9% of monthly premiums, below the 2026 rate.
- State exchange on the federal platform: 1.5% of monthly premiums, below the 2026 rate.
- Risk adjustment user fee: $0.18 per member per month, below 2026.
- Catastrophic plans may span up to 10 consecutive plan years.
The rule also tightened agent and broker marketing standards, expanded hardship exemption eligibility, and aligned income verification requirements with the Working Families Tax Cut legislation.
What to watch
Approved rates as state regulators finish their reviews, and enrolment when open enrollment for 2027 begins. The morbidity assumption in these filings is a prediction about who stays. Enrolment data is how it gets marked to reality.
Sources
- How much and why ACA Marketplace premiums are going up in 2027 — Peterson-KFF Health System Tracker
- HHS Notice of Benefit and Payment Parameters for 2027 Final Rule — Centers for Medicare & Medicaid Services
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