Health insurance costs: 2027 premiums rise again as open enrollment nears

The extra Obamacare subsidies ended in 2025 and enrollment fell. Open enrollment for 2027 starts November 1, with a median proposed premium increase of about 15% and insurers leaving 24 states.

What happened

Enhanced premium tax credits for Affordable Care Act marketplace plans, created in 2021 and extended through 2025, expired at the end of 2025. They had capped premiums at 8.5% of income for people above 400% of the poverty line and lowered costs for lower-income enrollees.

What changed in 2026 (KFF)

• Sign-ups fell by over 1 million to 23.1 million, the sharpest one-year drop since the marketplaces opened.

• The average monthly premium people paid rose 58%, from $113 to $178.

• The average deductible rose 37% to a record $3,786 as people moved to cheaper bronze plans.

What's coming for 2027

• Open enrollment begins November 1 in most states.

• The median proposed premium increase is about 15%, ranging from under 7% in a few states to 29% in Arizona.

• Insurers are leaving the marketplaces in 24 states, so hundreds of thousands of people will need to pick a new plan; seven states each gain one new insurer.

• The out-of-pocket maximum rises to $12,000 for an individual, up from $10,600.

• Federal subsidies will be limited to citizens, green-card holders and a few other groups; refugees, asylees, people with Temporary Protected Status and people on work or student visas will no longer qualify.

• Some states are filling gaps: Virginia is adding state subsidies and Rhode Island set aside $19 million.

The case for restoring the subsidies

Supporters say the enhanced credits made coverage affordable for millions, that losing them pushes healthy younger people out of the market and raises costs for everyone left, and that health costs are a top voter concern.

The case against

Opponents say the enhanced credits were a temporary pandemic measure, cost tens of billions of dollars a year, sent help to higher earners, and covered up the underlying problem of high premiums. Many favor alternatives such as cheaper plan options, health savings accounts or employer-funded arrangements.

What to watch

How many people re-enroll after November 1, whether a post-election tax or spending deal revives some form of the enhanced credits, and the December 31 deadline for community health center funding.