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ACA Marketplace premiums might see a double-digit spike in 2027

The early look at ACA Marketplace premiums shows that the tax credit lapse and rising medical cost trend could lead to high premium costs for consumers in 2027.

Sara Heath
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Published: 29 Jun 2026

A preliminary analysis of publicly available rate filings for the Affordable Care Act individual Marketplace paints a foreboding picture for consumers, with some states estimating double-digit premium rate hikes for 2027.

The analysis, completed by researchers from the Georgetown University School of Public Policy, provides only an initial picture of the Marketplaces, with the researchers stressing that proposed premium rates are not due to federal regulators until later this summer.

Still, the researchers cautioned that the road ahead could be bumpy for Marketplace consumers next year.

In addition to potentially skyrocketing premiums, consumers can expect the Marketplaces to shrink as more payers plan to withdraw. Meanwhile, shoppers have already been squeezed as the lapse of enhanced premium tax credits has left many middle-income earners without financial assistance in buying a plan.

Notably, Marketplace premium hikes are expected to be higher in some places than others. For example, in Vermont, the statewide average proposed rate increase was 6.5%, with the lowest proposal being from Blue Cross Blue Shield of Vermont (5.2%) and the highest being MVP Health Plan, Inc. (7.3%).

Washington had the highest statewide average proposed rate increase at 22.4%. The most expensive issuer in the state is Coordinated Care Corporation (27.8%), and the least expensive was Regence BlueShield (8.6%).

However, there was remarkable variability in proposed rate increases in some states.

For example, New York's state average proposed rate increase was 20.7%, but its least expensive plan proposed a 1.4% increase (Capital District Physicians Health Plan Inc.). Meanwhile, New York's most expensive plan proposed a 52.1% rate increase, the highest rate hike proposed in the analysis.

What drives Marketplace rate increases in 2027?

Although this analysis is only a preliminary look at the 2027 Marketplaces, the researchers said that some states published details justifying their rate increases. This provides more insight into how various health policies are coming to shape the individual Marketplaces, they noted.

In a review of 40 rate increase justifications across eight states, the researchers concluded that rate hikes come down to three key factors: lapsing enhanced premium tax credits, uncertainty around the Notice of Benefit and Payment Parameters and rising healthcare costs.

According to the researchers, the lapse of enhanced premium tax credits raised premiums anywhere from 4% to 6%. This has led to smaller, sicker risk pools, and health plans say they need higher premium rates to cover this population.

Health plans also anticipate that risk pools will grow smaller and sicker as a result of the 2027 NBPP, which eliminates some consumer protections, increases the amount of paperwork members must complete upon enrollment and establishes user fees for plans participating in the exchanges. CMS estimates that the 2027 NBPP will reduce Marketplace enrollment by 1.2 to 2 million, prompting some plans to increase costs to account for higher-risk populations.

Moreover, the NBPP rule was filed after some plans had begun their 2027 rate filings and is currently being challenged in a lawsuit filed in June. This uncertainty is making it difficult for payers to accurately determine their costs going into 2027, as many indicated in their filings.

Finally, health plans indicated a rising medical cost trend. Indeed, the most recent data from PwC shows the medical cost trend for the individual Marketplace is projected to be 8.5% in 2027, up from 7.5% in 2026.

According to the reviewed early filings, health plans credit their increased rates to higher provider reimbursements, greater healthcare utilization rates and general medical cost inflation. A substantial subset also flagged higher pharmaceutical spending and provider consolidation as contributing to rate increases.

Again, it's early days for 2027 Marketplace rate filings, and many still haven't been completed or made public, the analysts stressed. Still, these initial numbers paint a striking picture for the upcoming plan year.

"Insurers are facing high health care cost growth, significant drops in enrollment, a worsening risk pool, and an unstable policy environment. Some ACA Marketplace consumers will be affected by insurer exits, and those who do not qualify for financial help may face double-digit rate hikes," the researchers concluded. "A more complete picture of rates and insurer participation in the 2027 Marketplace will emerge as rate filing season progresses."

Sara Heath is an executive editor at Xtelligent Healthcare Media, where she covers patient engagement, healthcare policy and health IT.

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