ACA open enrollment: Premium hikes and what else to expect for 2027

The window to sign up for 2027 healthcare coverage under the Affordable Care Act opens Sunday in most states.

With healthcare costs a top concern for Americans already slammed by sticky inflation, this year's enrollment — running through Dec. 15 to get a plan that starts Jan. 1 — comes at a time when monthly premiums are climbing and insurers are shutting plans.

For 2027, average full-price premiums on federal and state-run marketplace plans are set to increase by roughly 13%, according to a new KFF analysis published on Friday. Most price hikes across the country range from 10% to 20%.

States that run their own enrollment platforms are seeing premium increases of 16%, per the researchers.

The increases are being driven by a rise in overall medical care costs, inflation, and labor shortages.

"Automatically renewing your current coverage before looking at alternatives is a big mistake," Louise Norris, a health policy analyst for healthinsurance.org, told Yahoo Finance.

This will be the second year in a row of double-digit increases. For many people, 2026 ACA premiums jumped more than 20% and higher earners lost premium subsidies entirely.

Premium hikes vary widely from state to state. In Vermont, for example, there is likely to be an average increase of 3% compared to an average hike of almost 28% in Arizona.

In about half the states, the plans available are from the same insurance companies in 2027 as they were in 2026.

But those plans could be changing in terms of what they cover, what providers are in the network, what drugs are covered, the deductible amount, and the out-of-pocket maximum. Those are the sorts of things that change every year, Norris said.

And there are quite a few folks whose 2026 plan is not available for renewal next year. In 26 states, at least one insurer is leaving the marketplace.

"If it's your plan, it's a big issue to you," she added.

As of this past week, 11 carriers have announced that they will exit the ACA marketplaces, either in some or all states. Cigna, which has more than 350,000 ACA enrollees, will exit all 11 states where it offers ACA plans.

"We did not make this decision lightly and appreciate the importance of ensuring patients have continuity through the transition, and we will support members through their open enrollment transitions into 2027," Brian Evanko, Cigna Group's president and CEO, said in an earnings call. "This is a small business for us today, and it's been shrinking in recent years."