Open enrollment healthcare cost increases are showing up in both higher proposed premiums for 2027 and falling ACA Marketplace enrollment, with insurers proposing a median premium increase of about 15% for 2027, according to a KFF analysis of insurer rate filings.
Rate filings analyzed by the KFF Health System Tracker show a median proposed premium increase of 15% across 276 insurers participating in the ACA Marketplaces, and insurers cite rising medical trend, inflation, labor costs and prescription drug pressures as key drivers.
KFF’s broader Marketplace analysis finds that effectuated enrollment fell from 21.8 million in 2025 to 19.2 million in February 2026, a 12% decline, and links that drop to higher consumer premium payments after enhanced tax credits expired.
Insurer filings and KFF’s review both point to several mechanisms pushing premiums higher: a median medical trend of about 10% reported by insurers, continued general inflation, rising provider labor costs, increased claims severity, and select drug cost pressures such as wider use of GLP-1 medications.
For consumers, the combination of higher list premiums and expired enhanced subsidies meant average consumer premium payments net of tax credits rose sharply in 2026; KFF reports an average increase of about 58% in consumer payments for people who signed up for 2026 coverage.
State policy choices also mattered: KFF found state-based Marketplaces that offered state-funded subsidies saw smaller drops in enrollment than states using the federal HealthCare.gov platform, and New Mexico — which fully replaced the expired enhanced credits — was the only state to see enrollment grow.
If regulators approve the proposed 2027 rates, typical premiums in the ACA Marketplaces will have risen substantially over two years, and many analysts warn consumers should expect higher take-home premium costs during this open enrollment season.
For consumers shopping this fall, comparing plan premiums, deductibles and drug coverage matters more than ever; related reporting on Medicare rate and ACA refund developments may affect choices for some households.
Medicare rates 2027: Part D changes and Trump ACA refund checks: what to know are recent items that may influence how households weigh enrollment options this season.
Sources
- Peterson-KFF Health System Tracker — median proposed 15% premium increase and insurers’ cited drivers from 276 insurer filings.
- KFF — effectuated enrollment fell from 21.8 million to 19.2 million (a 12% decline) in 2026 and average consumer premium payments rose sharply.
