Health Insurance: 2027 Marketplace Shifts

Open enrollment for Affordable Care Act plans begins Sunday in most states.

The sign-up period runs through January 15, 2027.

Consumers face higher costs and fewer options this year.

Financial assistance, including premium tax credits and cost-sharing reductions, is now restricted for many groups that previously qualified.

KFF, a healthcare research nonprofit, analyzed new data from the Centers for Medicare & Medicaid Services.

The group projects the average price of marketplace health insurance will rise by 13% in 2027.

Cynthia Cox, a vice president and director of the ACA program at KFF, identified rising healthcare costs as a primary driver.

She also cited hospital market concentration and the impact of the No Surprises Act.

The No Surprises Act took effect in 2022 and bans surprise billing.

Cox noted that the rising availability of GLP-1 drugs also contributes to price increases.

People who do not qualify for a subsidy are most affected by these changes.

They may struggle to afford coverage into next year, Cox said. Many have already switched to bronze plans, which are the cheapest available options, she added. A fact sheet from CMS distributed Friday states that Americans using HealthCare.gov will have access to low-cost plans. This comes after ACA insurance prices rose sharply during the current administration. Republicans opposed extending pandemic-era subsidies that had helped offset costs during the previous administration. That policy shift resulted in 1.2 million fewer people signing up for coverage in the exchanges. Roughly 19.2 million people in the United States were actively enrolled in ACA marketplace health plans as of February, according to the Department of Health and Human Services. Enrollment grew during the pandemic when enhanced subsidies became available through the American Rescue Plan Act and the Inflation Reduction Act. New regulations starting in 2027 will limit tax credits for certain lawfully present immigrants. This change could result in an additional 1 million uninsured individuals over time. The administration has also been removing enrollees from the program as part of a campaign against waste, fraud, and abuse. In September, Vice President JD Vance and other officials announced plans to remove 760,000 ACA enrollees from public healthcare exchanges. They alleged these individuals were fraudulently enrolled or did not exist. Vance said the discovery and canceled subsidy payments would result in $2.2 billion in cost savings. It is unclear how many more people will drop off ACA coverage in 2027, Cox said. With higher premiums, immigration eligibility changes, and anti-fraud efforts, she expects fewer people to be enrolled in this market. She added that it will be harder to understand why enrollment numbers change under these conditions.