ACA 2027 Coverage Will Cost More and Offer Fewer Choices

For 2027, Affordable Care Act marketplace shoppers can expect a narrower plan selection and higher premiums. Enrollment begins Sunday in most states and continues through Jan. 15. Other changes include tighter eligibility reviews, possible slowdowns when using brokers, reduced financial help and new limits affecting immigrants.

KFF’s review of new CMS data projects that marketplace insurance prices will increase by an average of 13% in 2027. Cynthia Cox of KFF attributed the rise mainly to growing medical expenses and hospital consolidation, while also identifying the No Surprises Act and wider availability of GLP-1 drugs as possible factors. People without subsidies are expected to feel the increases most. Many have already shifted to bronze coverage, the marketplace’s least expensive tier.

Financial assistance is now unavailable to some groups that previously qualified. Rules beginning in 2027 will also narrow tax-credit eligibility for certain immigrants who are lawfully present, potentially leaving another 1 million people uninsured over time. Separately, the Trump administration announced in September that 760,000 enrollees would be removed over alleged improper or nonexistent enrollment. Officials projected $2.2 billion in savings. About 19.2 million people had active marketplace plans as of February, following an earlier enrollment decline of 1.2 million.