ACA Marketplace 2027 silver premiums rise 13%, KFF reports

The Affordable Care Act Marketplace 2027 Open Enrollment period begins on November 1, 2026, in most states, bringing average benchmark silver premium increases of 13% alongside a series of regulatory shifts, expiring federal tax credits, and tightened eligibility rules, kff.org reported.

Key Clinical Takeaways:
• Benchmark silver premiums are rising by an average of 13% for 2027, following a 26% increase from 2025 to 2026.
• Individual market enrollment fell by 18% to 20.5 million people by June 2026, driven by the expiration of enhanced premium tax credits.
• The Congressional Budget Office projects ACA Marketplace enrollment will decline from a peak of 22.4 million in 2025 to 13.1 million in 2027.

Benchmark Silver Premiums Rise by 13 Percent

Insurers proposed a median premium increase of 15% for 2027, resulting in a finalized average increase of 13% for benchmark silver premiums. This marks a second consecutive year of double-digit proposed increases following a 26% jump from 2025 to 2026. States utilizing the Healthcare.gov platform are seeing an 11% increase in benchmark silver premiums, while state-run platforms face an average increase of 16%. Insurers attribute these adjustments to rising underlying healthcare costs and the expiration of enhanced premium tax credits, which they estimate added roughly four percentage points to premiums in 2026 with a similar impact expected for 2027. Enrollees with incomes exceeding 400% of the federal poverty level face the full brunt of these costs, having lost eligibility for premium tax credits entirely.

Enrollment Drops as 11 Carriers Exit States

Marketplace plan selections dropped by 1.2 million during the 2026 Open Enrollment Period compared to the previous year. By February 2026, effectuated enrollment fell 12% to 19.2 million people. Broader individual market data shows an 18% drop by June 2026, reducing enrollment from 25.2 million to 20.5 million. Citing these market deteriorations, 11 carriers announced plans to exit at least one state for the 2027 plan year as of October 29, 2026, outnumbering the seven carriers entering new states. Cigna confirmed it is leaving the individual market across all 11 states where it currently operates.

States Deploy Subsidies as Federal Fraud Controls Tighten

To mitigate the loss of federal assistance, several state-based exchanges are deploying state-funded subsidies for 2027. New Jersey, Rhode Island, and Virginia have also established or maintained state-specific subsidy structures. Concurrently, federal efforts to combat broker fraud led the Department of Health and Human Services to cancel coverage for approximately 760,000 phantom enrollees in September 2026. New safeguards in the Notice of Benefit and Payment Parameters for 2027 bar agents and web-brokers from offering cash rebates or misrepresenting zero-dollar premiums, while a temporary restriction pauses the registration of new agents and brokers on the federal platform through February 2027.

Immigrants Lose Eligibility for Premium Tax Credits

Lawfully present immigrants who are not lawful permanent residents, Cuban and Haitian entrants, or lawful residents living in the U.S. under the Compact of Free Association can still purchase Marketplace coverage for 2027 but will no longer qualify for premium tax credits under the 2025 budget reconciliation law. The Congressional Budget Office estimates this provision will add one million individuals to the uninsured population by 2035. Limits capping the repayment of excess premium tax credits were eliminated starting in the 2026 tax year. Enrollees selecting 2027 coverage will do so without prior exposure to uncapped repayments, making accurate income projections critical for households near subsidy thresholds.

Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.