ACA open enrollment starts with higher premiums and fewer options for 2027

The open enrollment period for the Affordable Care Act marketplace opens Sunday in most states, running through January 15. Individuals preparing to purchase health insurance should anticipate a series of structural changes for the 2027 coverage year. These shifts include higher premium rates, reduced availability of financial subsidies, and tighter administrative controls.

Financial assistance, such as premium tax credits and cost-sharing reductions, will no longer be available to many demographic groups that previously qualified. This contraction in aid coincides with rising base rates for all tiers of insurance plans. The Department of Health and Human Services distributed a fact sheet on Friday stating that users of HealthCare.gov will maintain access to low-cost plans, a claim that contrasts with independent cost projections.

KFF, a healthcare research nonprofit, analyzed new data from the Centers for Medicare & Medicaid Services to forecast market trends. Their analysis projects that the average price of health insurance purchased through the marketplaces will rise by 13 percent in 2027. This increase follows a period where the cost of ACA coverage climbed sharply after Republicans opposed extending pandemic-era subsidies.

Cynthia Cox, vice president and director of the ACA program at KFF, identified several drivers for the price hike. She cited rising general healthcare costs and increased concentration in hospital markets as primary factors. She also pointed to the impact of the No Surprises Act, which took effect in 2022 to ban surprise billing, and the growing market presence of GLP-1 drugs as contributing elements.

The financial burden will fall heaviest on enrollees who do not qualify for subsidies. Cox noted that many of these individuals have already switched to bronze plans, which are the least expensive tier available. She expressed uncertainty about their ability to maintain coverage, stating, “They may or may not be able to afford to continue to keep their coverage into next year.”

New regulations effective in 2027 will also restrict tax credits for specific lawfully present immigrants. These changes could leave an additional one million individuals without insurance over time. The administration has characterized these moves as part of a broader effort to combat waste, fraud, and abuse within the public exchanges.

Vice President JD Vance announced in September that the administration planned to remove 760,000 people from ACA exchanges. Officials alleged that these individuals were either fraudulently enrolled or did not exist. Vance said the cancellation of subsidy payments for these enrollees would generate $2.2 billion in savings for the government.

The total number of active ACA enrollees has shifted in recent years. As of February, approximately 19.2 million people in the United States were enrolled in marketplace health plans. This figure represents a decrease of 1.2 million people compared to peak enrollment periods, a drop attributed to the expiration of enhanced subsidies during the previous administration.

Enrollment numbers grew during the pandemic due to the American Rescue Plan Act and the Inflation Reduction Act. Both laws were signed by President Joe Biden and provided temporary financial boosts to marketplace participants. The current enrollment window marks the first major sign-up period under the new regulatory and pricing framework.

Cox stated that it is unclear how many more people will lose coverage in 2027. However, she predicted a decline in total enrollment due to the combination of higher premiums, immigration eligibility changes, and anti-fraud initiatives. She added, “I think there’s going to be fewer people enrolled in this market, but it’s going to be harder to understand why.”