ACA Marketplace Opens With 13% Premium Hike and 11 Insurers Gone

Americans who buy their own health insurance through the Affordable Care Act marketplace entered open enrollment Sunday facing a landscape that's gotten measurably harder to navigate: higher monthly costs, fewer companies selling plans, less broker help to sort it all out, and tighter eligibility rules for some immigrant households.

The enrollment window for 2027 coverage opened November 1 in most states and runs through January 15, according to KFF's 2027 open enrollment analysis. For shoppers in Idaho, Connecticut, and Massachusetts, it started even earlier.

The sticker shock comes first. According to KFF's review of insurer filings across all 50 states and Washington, D.C., the average increase in finalized benchmark silver premiums for 2027 is 13%, the second consecutive year of double-digit jumps, after a 26% increase from 2025 to 2026. Insurers proposed a median increase closer to 15%, and 51 companies asked for more than 25%, according to reporting by Medical Daily.

In their rate filings, insurers pointed to two main drivers: a higher-than-usual jump in the underlying cost of care, which isn't unique to ACA plans, and the end of enhanced premium tax credits that expired at the close of 2025. Those credits kept premiums artificially low for millions of enrollees for several years. Without them, healthier people dropped coverage, leaving a sicker, more expensive risk pool for the companies that stayed.

Some of those companies haven't stayed. Eleven insurers have announced plans to leave some state ACA marketplaces for 2027, according to NBC News. That means consumers in at least 24 states will find fewer options on their exchange this season, according to Medical Daily. Less competition among insurers is associated with higher premiums, researchers at Georgetown's Center on Health Insurance Reforms noted in a recent analysis.

The coverage losses are already showing up in enrollment numbers. During the 2026 open enrollment period, plan selections fell by 1.2 million from 2025, according to KFF. That shrinking pool raises further concerns about the long-term viability of the risk mix.

Finding help shopping won't be as easy, either. The Centers for Medicare and Medicaid Services issued a rule in September placing a moratorium on brokers new to offering ACA coverage. As reported by NPR, agents who weren't registered with the federal marketplace in 2026 can't assist with 2027 enrollments until at least February, which is after open enrollment closes. That's a meaningful gap: brokers are often the people who sit with consumers and walk them through network comparisons, especially in rural areas where online literacy is inconsistent.

New identity verification requirements are also in place this year. CMS has added additional checks designed to catch fraudulent enrollments, a problem that made headlines in 2025. Health policy experts told NPR these checks are a reasonable response to the fraud problem, but they could also slow down legitimate applications and create an added hurdle for people in time-sensitive situations, like someone who just lost job-based coverage.

Immigrant families face an additional layer of change. New rules limit which non-citizen groups can access premium subsidies, reducing options for households that previously qualified.

For people who auto-renew without shopping, the risk is real. A consumer in a state where their current insurer is exiting the market could get moved to a different plan entirely, with a different premium, different deductible, and a different provider network, without making any active choice. Clinicians who work with underinsured or recently uninsured patients know what that kind of disruption does to continuity of care: follow-up appointments get missed, prescriptions lapse, chronic conditions go unmanaged.

The advice from health coverage navigators is the same this year as it's always been, except more urgent: don't auto-renew without checking. The plan that worked in 2026 may not exist in 2027, and even if it does, it will almost certainly cost more.

Sources cited:
- KFF: 9 Things to Watch for the 2027 ACA Open Enrollment Period (https://www.kff.org/affordable-care-act/9-things-to-watch-for-the-2027-aca-open-enrollment-period/)
- NBC News: Many with ACA coverage face a new crisis in 2027 (https://www.nbcnews.com/health/health-care/many-aca-coverage-face-new-crisis-2027-insurers-fleeing-market-rcna606211)
- NPR: It's ACA open enrollment time. Here are the changes for health insurance shoppers (https://www.npr.org/2026/11/01/nx-s1-6023423/aca-open-enrollment-health-insurance)
- Medical Daily: ACA Shoppers Face Insurer Exits in 24 States and Rising Premiums (https://www.medicaldaily.com/aca-open-enrollment-2027-insurer-exits-premium-increases-480570)