ACA open enrollment is here, and a lot has changed since last year. For many shoppers, 2027 will feel more expensive, more confusing, and more important to review closely.
Premiums are rising, even if many people still get help
The 2027 ACA open enrollment period begins November 1, 2026, in most states, and premiums are moving up fast. Finalized benchmark silver premiums for 2027 are rising by 13% on average, after a huge 26% jump from 2025 to 2026. In states using Healthcare.gov, benchmark silver premiums are increasing 11%, while state-run marketplaces are seeing a 16% increase.
Insurers say the main driver is the rising underlying cost of care, and that pressure is not limited to ACA plans. In rate filings, carriers also pointed to the expired enhanced premium tax credits and the effect on the risk pool. On average, insurers estimated risk-pool changes added about 4 percentage points to premiums in 2026 and expect a similar effect again in 2027.
Most marketplace enrollees still receive subsidies, which will soften some of the increase in 2027. But households above 400% of the federal poverty level no longer qualify for premium tax credits, so they may have to absorb the full price. That matters more now because the benchmark plan itself costs significantly more than it did just 2 years ago.
Enrollment and insurer choice are both getting tighter
Marketplace enrollment already slipped after the enhanced premium tax credits expired. During the 2026 open enrollment period, plan selections fell by 1.2 million from 2025, and effectuated enrollment dropped 12% by February 2026 to 19.2 million people. By June 2026, total individual market enrollment had fallen from 25.2 million to 20.5 million, a loss of more than 4.6 million.
The outlook for 2027 suggests more pressure ahead. The Congressional Budget Office projected ACA marketplace enrollment could fall from 22.4 million in 2025 to 13.1 million in 2027. Some insurers have said people who managed to keep coverage in 2026 may struggle even more in 2027 as higher premiums continue to squeeze household budgets.
Choice may shrink too. As of October 29, 2026, 11 carriers had announced exits from at least one state for 2027, while only 7 had announced entry into a new state. Cigna is leaving the individual market in all 11 states where it currently participates, a move that could mean fewer plan options and narrower provider networks in some areas.
New rules on subsidies, brokers, and eligibility will reshape coverage
Some states are stepping in where federal help has faded. New Mexico fully backfilled lost enhanced federal assistance in 2026 and is continuing that support in 2027, while California is expanding state-funded premium help to households between 165% and 200% of the federal poverty level. Rhode Island, Virginia, and New Jersey also have state-specific subsidy efforts, though the amount of help varies by state.
Federal policy changes are also affecting who gets coverage and how people enroll. In September 2026, HHS said it cancelled coverage for about 760,000 people it identified as possible “phantom” enrollees, and CMS sent insurers roughly 1.2 million records for review. HHS also temporarily paused new agent and broker registration in the federally facilitated marketplace until February 2027, which could reduce enrollment help.
Other 2027 changes hit eligibility directly. Certain lawfully present immigrants will still be able to buy marketplace coverage, but only some groups, including lawful permanent residents and certain Cuban and Haitian entrants, will still qualify for tax credits. Repayment caps on excess premium tax credits are also gone starting with the 2026 tax year, and in states implementing Medicaid work requirements by 2027, some people denied Medicaid for not meeting those rules will also be blocked from marketplace subsidies.
