KFF’s analysis of preliminary 2027 rate filings landed in July with a number that should’ve made bigger headlines than it did: a median proposed premium increase of 14% across 77 insurers in 16 states and DC. By September, once KFF expanded the analysis to all 50 states and DC, that median had settled around 15%. Either way, it’s the second straight year of double-digit hikes, stacked directly on top of 2026’s finalized 20% median increase. If you buy your own health insurance on the marketplace, your premium has now jumped by something like a third in two years.

Open enrollment for 2027 coverage starts November 1, 2026, and runs through January 15, 2027 in most states (the deadline for a January 1 start date is December 15). That gives you roughly seven weeks between now and the day plans go live to actually look at what’s coming and plan around it, instead of getting the number sprung on you in your renewal notice.

Here’s what’s driving the increase, who’s absorbing the worst of it, and what to do with the time you’ve got left.

Quick Verdict

2027 median proposed increase	14–15% (KFF, preliminary filings)
2026 finalized median increase	20% — this is the second straight double-digit year
Root cause	Enhanced premium tax credits expired Dec. 31, 2025; not renewed by Congress
Who loses subsidies entirely	Anyone earning 400%+ of the federal poverty level ($62,600/year for a single person in 2026)
2027 out-of-pocket max	$12,000 individual, up from $10,600 in 2026
Enrollment impact so far	Plan selections fell from 24.2M to 23.1M for 2026 coverage, per KFF
Open enrollment window	Nov. 1, 2026 – Jan. 15, 2027 (most states); Dec. 15 deadline for Jan. 1 coverage
What to do now	Run your subsidy math before Nov. 1, not after your plan auto-renews

Why ACA Premiums Are Going Up Again in 2027

Insurers file two reasons over and over in their 2027 rate justifications, and they’re related. The first is ordinary: rising hospital and drug prices, general inflation, labor costs in healthcare. Nothing new there. The second is the one actually driving the size of the increase: the enhanced premium tax credits from the pandemic-era American Rescue Plan expired at the end of 2025, and Congress didn’t renew them.

Those enhanced credits did two things while they existed. They made subsidies bigger for people who already qualified, and they removed the income cap entirely, so households earning any amount could get some help if the benchmark plan cost more than 8.5% of their income. Both of those went away on January 1, 2026. What came back is the pre-2021 rule: subsidies only for households between 100% and 400% of the federal poverty level, full price above that line.

That matters for the rate filings because of who left. KFF’s analysis points to the predictable result: healthier people, especially those just above the subsidy cliff who felt the sticker shock hardest, dropped coverage rather than pay full price. Sicker enrollees, who need coverage regardless of cost, mostly stayed. That leaves insurers covering a smaller, costlier risk pool, and they’re pricing 2027 premiums to match it.

The 400% FPL Subsidy Cliff, Explained

If your household income is at or above 400% of the federal poverty level, you get zero ACA premium tax credit under current rules — not reduced, zero — no matter how large your unsubsidized premium is. For 2026, that threshold is $62,600 for a single person and scales up with household size. One dollar over the line and you’re paying the full, unsubsidized rate; one dollar under it, you still get help. There’s no phase-out at the top anymore. It’s a cliff, not a slope.

This isn’t a new rule invented for 2027. It’s the standard ACA subsidy structure that was in place before 2021. What changed is that the enhanced credits which temporarily erased this cliff are gone, and nobody who’s shopped the marketplace since 2021 has had to think about it until now.

What Actually Happened to Enrollment in 2026

The subsidy cliff isn’t theoretical. Marketplace plan selections fell from 24.2 million to 23.1 million between the 2025 and 2026 open enrollment periods, the sharpest single-year drop since the exchanges launched, according to KFF’s tracking of sign-up data. People above the subsidy cliff made up a small share of total 2025 enrollment but accounted for nearly half of that decline — exactly the pattern that pushes insurers toward the rate increases they’re now filing for 2027.

Subsidized enrollees who stayed in their plans are paying substantially more too: KFF estimates their average annual premium payment roughly doubled year over year once the enhanced credits disappeared. That’s before the 2027 increase gets layered on top.

The Out-of-Pocket Max Is Rising Too

Premiums aren’t the only number moving. The federal out-of-pocket maximum for 2027 marketplace plans rises to $12,000 for individual coverage, up from $10,600 in 2026 — about a 13% jump, set by HHS using the ACA’s standard cost-growth formula. Family coverage caps out at $24,000, up from $21,200. That’s the most you’d pay in a worst-case year if you actually get sick or hurt, on top of whatever your monthly premium already costs. Budget for both numbers, not just the one on your premium bill.

If you’re on a high-deductible plan and eligible for an HSA, this is exactly the kind of year to actually fund it — our best HSA apps guide breaks down which accounts let that money grow instead of sitting in cash while you wait to need it.

How Much and Why: A 60-Second Breakdown

1. 14–15% median proposed increase for 2027 — per KFF’s analysis of preliminary insurer rate filings, first across 16 states and DC, later expanded to all 50 states and DC.
2. Second straight double-digit year — 2026’s finalized median increase was 20%, meaning marketplace premiums have climbed roughly a third in two years combined.
3. Root cause: expired subsidies, not just healthcare inflation — the enhanced premium tax credits lapsed Dec. 31, 2025, and Congress hasn’t renewed them.
4. A sicker risk pool — healthier, price-sensitive enrollees left when their subsidies disappeared; insurers are pricing 2027 to cover who’s left.
5. Final rates aren’t locked yet — these are preliminary filings; state regulators can adjust them before open enrollment, though final rates rarely swing far from the proposed median.

Who Gets Hit Hardest

Anyone above 400% FPL with no employer coverage absorbs the full increase with zero subsidy cushion — for a single person, that’s income above $62,600. Early retirees, freelancers, and small business owners who buy their own insurance and earn a solid but not enormous income are the group most likely to open their renewal notice and see the whole 14-15% (or more, depending on their plan and state) with nothing offsetting it.

People just under the cliff aren’t fully sheltered either. Subsidies scale to a percentage of income, so even a subsidized household is still exposed to some of the increase — just not all of it.

People in the individual market generally should expect this to keep compounding. Two years of double-digit hikes back to back isn’t a one-time correction; it’s a new baseline the market is settling into now that the enhanced credits aren’t coming back to reset it.

What to Actually Do Before Nov. 1

You don’t need the final rate to start preparing. A few things worth doing in the next seven weeks:

• Estimate where your household income lands relative to 400% FPL now, not after your plan auto-renews at a price you didn’t see coming. If you’re close to the line, small income changes (retirement account contributions, timing a bonus, self-employment deductions) can shift which side of the cliff you land on.
• Don’t let your current plan auto-renew without checking the math. Auto-renewal is convenient and it’s also how people end up paying 14-15% more for a plan that isn’t even the cheapest option in their metal tier this year. Shop it on Nov. 1.
• Build the premium increase into your budget now, not in January. If a recession-proofing budgeting app already has your fixed costs mapped out, add a placeholder line for the new premium as soon as you have an estimate, even before open enrollment opens.
• Park whatever you’re setting aside for the higher premium or out-of-pocket max somewhere it earns something. A comparison of current high-yield savings options is worth a look if that money’s just sitting in a checking account between now and when the bill hits.
• If medical bills are already a stress point, know the credit reporting rules changed this year too. Our breakdown of medical debt and credit reports in 2026 covers what’s actually protected and what isn’t, state by state.
• If you’re also tracking the COLA and Medicare Part B situation, the same “budget off the current number, not the optimistic one” logic applies — see our 2027 Social Security COLA piece for the parallel math on the Medicare side.

The Bottom Line

Preliminary 2027 ACA rate filings show a 14-15% median premium increase, the second straight double-digit year after 2026’s 20% jump, and the driver isn’t a mystery: enhanced subsidies expired, the 400% FPL cliff is back, and insurers are pricing a sicker risk pool now that healthier, unsubsidized enrollees have started dropping out. None of that is final until state regulators sign off on the actual 2027 rates. But the direction isn’t in question, and open enrollment starts Nov. 1. Run your numbers before your plan renews itself for you.

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Premium increase data from KFF’s analysis of preliminary 2027 rate filings and the updated nationwide analysis. Enrollment figures from KFF’s tracking of 2026 open enrollment sign-ups. Out-of-pocket maximum figures reflect HHS’s 2027 cost-sharing parameters. Figures reflect preliminary filings as of September 2026; final approved rates may differ once state regulators complete their review ahead of the Nov. 1, 2026 start of open enrollment.