Health insurance premiums on Affordable Care Act (ACA) marketplaces are set to increase by an average of approximately 15 percent in 2027, marking the second consecutive year of notable rate hikes. This increase will affect millions of Americans who rely on these marketplaces for coverage, many of whom are already struggling with rising costs across other areas of daily life.

Marketplace enrollment declined by nearly 3 million people during a 12-month period ending in early 2026, leaving about 20.5 million participants as of June, according to data from a health policy nonprofit. Analysts warn that increasing premiums, along with the lasting effects of reduced subsidies and policy changes implemented by the previous administration, could lead to an additional loss of roughly 5 million ACA enrollees by year-end.

Several factors have contributed to the rising premiums. Insurers cite labor shortages, escalating healthcare expenses, and increased utilization of medications such as GLP-1 drugs. The expiration of pandemic-era subsidies played a significant role in the dramatic premium increases observed in 2026, and the trends are expected to continue. While private employer-based health insurance premiums are predicted to rise less sharply—around 8.2 percent according to a recent employer survey—many marketplace participants will face larger increases.

The burden of premium hikes will be most pronounced among individuals and families with incomes exceeding four times the federal poverty level—for example, individuals earning above $63,840 annually or four-person households with incomes over $132,000—since these groups do not qualify for premium tax credits that help offset costs. Approximately 2.5 million ACA enrollees nationwide received no subsidies as of early 2026.

Geographically, some states are facing especially steep increases. Arizona, New Mexico, and Montana are projected to experience average premium hikes exceeding 20 percent. For example, a 40-year-old in Arizona earning $65,000 on a Blue Cross Blue Shield plan saw premiums rise by around 48 percent from 2025 to 2026, with an expected additional 25 percent increase in 2027. In some cases, monthly premiums have grown from around $300 in 2025 to more than $550 projected for next year.

Several insurers are retreating from the ACA marketplaces. Cigna Group announced its exit from 11 states earlier this year, affecting nearly 370,000 policyholders, and Aetna left the exchange in 2026, impacting about one million consumers. These departures further narrow the choices available to marketplace enrollees, though a handful of smaller insurers intend to enter select markets.

Some consumers are exploring alternatives to traditional marketplace coverage. For instance, a family in Arizona has opted for a direct primary care model due to marketplace premiums exceeding $2,500 monthly. Others have switched to private insurance plans or are facing difficult decisions about whether to maintain coverage in the face of rising costs.

Policy discussions in Washington continue to focus on potential measures such as expanding Medicare and restoring ACA subsidies, topics that have become central in upcoming midterm election debates. Meanwhile, officials from the former Trump administration attribute part of the marketplace enrollment decline to their efforts to reduce fraud, including the removal of around 760,000 suspected fraudulent enrollees. The impact of these removals on 2027 rates remains uncertain.

Experts note that higher premiums tend to disproportionately affect healthier individuals who may choose to forgo coverage, leading to a riskier insured pool and potentially further premium increases. Premium tax credits play a crucial role in maintaining a stable enrollment mix by making insurance more affordable for lower-income enrollees. However, for those without subsidy eligibility, the coming year promises to be challenging amid ongoing affordability concerns.