The ACA marketplace is heading into its second consecutive year of double-digit premium increases, and the mechanism is not a mystery. When enhanced premium tax credits expired at the end of 2025, millions of healthier, younger enrollees found the cost of coverage no longer workable and dropped their plans. The risk pool that remained was older and sicker. Insurers priced that into their 2027 rate filings, and the numbers are significant across the states where it matters most.
A new KFF analysis covering 276 insurers with publicly available filings across all 50 states and the District of Columbia, found a national median proposed premium increase of 15% for 2027. That follows a finalized median increase of 20% in 2026, making 2027 the second-highest requested rate cycle since 2018.
Ohio's 11 remaining marketplace insurers are proposing an average 14.7% increase for 2027, according to a Center for American Progress analysis. In Georgia, proposed increases on the state-run Georgia Access exchange are on track to reach 20% or more, according state data reported by the Georgia Recorder. Florida's insurers, meanwhile, are projecting another round of double-digit hikes, the Associated Press reported.
All three are proposed rates, subject to state regulatory review. Final 2027 rates are expected before open enrollment begins November 1.
The pattern in 2027 filings was documented throughout 2026. When enhanced subsidies expired, open enrollment sign-ups fell to 23.1 million from 24.2 million in 2025, the sharpest single-year drop since the marketplaces launched, according to KFF. As grace periods expired, effectuated enrollment fell further to 19.2 million by February 2026, based on federal data reported by KFF in July. KFF projected total 2026 enrollment could settle between 16.5 million and 17.5 million by year's end.
Young adults led the exodus. Adults aged 18 to 34 accounted for 46% of the total decline in plan sign-ups, according to KFF's May enrollment analysis. People with incomes just above the subsidy cliff - between 400% and 500% of the federal poverty level - saw sign-ups fall 44%, despite representing only 3% of 2025 enrollment. Those who stayed shifted toward higher-deductible plans. The bronze-plan share of enrollment jumped from 30% to 40%, while the silver-plan share fell from 57% to 43%. Average deductibles reached a record $3,786, up $1,027 from 2025.
Wakely Consulting Group, analyzing data from plans representing roughly 80% of individual market enrollment, estimated that morbidity in 2026 deteriorated by 2.9% to 6.5% compared to 2025. Insurers filing 2027 rates have reflected that shift directly, with KFF's August analysis finding carriers attributing roughly 4 percentage points of proposed 2027 increases specifically to morbidity worsening from subsidy expiration and continued enrollment contraction.
The scale of enrollment loss has varied sharply by state. Ohio recorded a 20% drop in marketplace sign-ups for 2026, the third steepest in the country behind North Carolina and West Virginia, according to KFF's May enrollment analysis. Of the roughly 497,000 Ohioans who had marketplace coverage in 2025, about 161,000 dropped it after subsidies expired, the Ohio Capital Journal reported, citing Center for American Progress data. With fewer, sicker enrollees remaining, Ohio's marketplace insurers are now proposing that 14.7% average 2027 increase.
Georgia's situation is more acute. Georgia had 1.3 million marketplace enrollees at the start of 2026. By April 17, only 950,000 held active policies, a 28% post-enrollment decline and the largest of any state reporting mid-year data, according to the Georgia Recorder and figures from the Georgia Office of the Commissioner of Insurance. The average net monthly premium for a Georgia enrollee rose from $74 in 2025 to $164 in 2026. Georgia hospitals lost an estimated $441 million attributable to those coverage losses, based on calculations by Georgia Hospital Association lobbyist Monty Veazey, as reported by the Georgia Recorder.
Florida accounts for close to one-fifth of total national ACA enrollment, with 3.8 million marketplace enrollees at its peak, according to KFF. About 440,000 Floridians dropped coverage in 2026, the largest raw number of any state, the Associated Press reported. Florida's concentration of gig workers, contractors, and small business owners makes the effect especially visible, given those sectors rely heavily on the individual market for coverage.
KFF data shows that about 48% of adult individual market enrollees are employed by small businesses with fewer than 25 workers, are self-employed, or are small business owners. That overlap with the small employer and self-employed segment is where many benefits brokers operate.
Open enrollment for 2027 coverage begins November 1 in Ohio and Florida, both of which use the federal HealthCare.gov platform. Georgia, which runs its own exchange, opens October 19. The deadline to select a plan with a January 1, 2027 effective date is December 15 across all three states. For brokers serving clients in any of these markets, the active window for coverage conversations is now, before November.
For clients above the subsidy cliff, another double-digit increase on top of last year's shock changes the cost arithmetic between individual market coverage and a small group plan.
Peterson-KFF Health System Tracker data published in December 2025, using the most recent available NAIC insurer filings, put average individual market premiums at $540 per member per month and fully insured employer coverage at $587. Individual market premiums grew substantially faster than group premiums in 2026, per Peterson-KFF's February analysis, so that gap has likely narrowed further or reversed - though updated per-member figures are not yet available.
As marketplace premiums continue to rise, ICHRA adoption jumped 53% in 2026, with large and small employers shifting toward defined-contribution models that give workers portability without locking the employer into group renewal costs.
For clients remaining on marketplace plans, a recent court decision staying key provisions of the administration's 2027 ACA eligibility rule means enrollment access is somewhat less restricted than it would have been. That context is worth knowing before conversations begin with clients on subsidy-eligible plans.
Cigna will not offer marketplace plans in any state for 2027, following Aetna's exit for 2026. Brokers with clients on either carrier need to initiate coverage transitions before enrollment opens. Small group premiums face a proposed median increase of 14% for 2027, meaning the alternative to the individual market is not cheaper - but it does offer more predictable cost structure and broader ACA consumer protections for clients making the switch.
