ACA open enrollment begins Sunday with higher 2027 premiums

The Affordable Care Act open enrollment period starts Sunday in most states and will continue through Jan. 15. Individuals who sign up during this window will face a different set of financial realities in 2027 compared to previous years. These changes include higher premiums, fewer available coverage options, and stricter eligibility requirements for financial assistance.

The healthcare research nonprofit KFF analyzed new data from the Centers for Medicare & Medicaid Services to estimate the financial impact for 2027. The analysis predicts that the average price of health insurance purchased through federal marketplaces will rise by 13%. This increase follows a period where Republicans opposed extending the temporary pandemic-era subsidies that had lowered costs for most enrollees during the Biden administration.

Cynthia Cox, a vice president and director of the ACA program at KFF, identified several factors driving the price hike. She pointed to rising general healthcare costs and increased hospital market concentration. She also cited the ongoing effects of the No Surprises Act, which took effect in 2022 to ban surprise billing, and the growing availability of GLP-1 drugs as potential contributors to higher rates.

The financial burden of these increases will fall most heavily on individuals who do not qualify for subsidies. Cox noted that many of these consumers have already shifted to bronze plans, which are the cheapest options available. She stated that these individuals may struggle to afford continued coverage into next year. "They may or may not be able to afford to continue to keep their coverage into next year," Cox said.

A fact sheet distributed by CMS on Friday stated that Americans using HealthCare.gov will have access to low-cost plans. However, the landscape of eligibility has shifted. Financial help, including premium tax credits and cost-sharing reductions, is now restricted for many groups that were previously eligible. New regulations starting in 2027 will also limit tax credits for certain lawfully present immigrants.

As of February, roughly 19.2 million people in the United States were actively enrolled in ACA marketplace health plans, according to the Department of Health and Human Services. This number grew during the pandemic when enhanced subsidies became available through legislation signed by President Joe Biden. However, the expiration of those subsidies has already resulted in 1.2 million fewer people signing up for coverage in the exchanges.

The Trump administration has also pursued a campaign to remove enrollees it characterizes as fraudulent. In September, Vice President JD Vance and other officials announced plans to remove 760,000 ACA enrollees from public healthcare exchanges. The administration alleged that these individuals were fraudulently enrolled or did not exist. Vance said that canceling these subsidy payments would result in $2.2 billion in cost savings.

Cox said it is unclear how many additional people will drop off of ACA coverage in 2027. She attributed this uncertainty to the combination of higher premiums, immigration eligibility changes, and the administration's anti-fraud efforts. "I think there’s going to be fewer people enrolled in this market, but it’s going to be harder to understand why," Cox said.

The open enrollment period allows residents to choose their health insurance plans for the upcoming year. Consumers can use brokers or sign up directly through the marketplace. The deadline to make these choices remains Jan. 15 for most states.