Vermonters who buy their own health insurance will pay about 3% more for it next year. In Arizona, insurers have asked for 29%.
Most states fall closer to Arizona than to Vermont. Across 276 insurers in all 50 states and Washington, DC, the median proposed increase for 2027 is 15%, according to the Peterson-KFF Health System Tracker. Requests ranged from a 1% cut to a 54% hike, and 51 carriers asked for more than 25%. With about half the states finalized, the enrollment-weighted national average is also close to 15% according to ACA Signups estimates.
Last year the median finalized increase was 20%. If this year's requests hold, KFF says, typical marketplace premiums will be up by more than a third in two years. Before 2026, premiums in this market had barely moved for most of a decade.
Read next: ACA premiums are rising again in 2027 - here's the broker conversation
Charles Gaba, who tracks rate filings at ACA Signups, puts the average full-price marketplace premium at about $741 a month in 2026. A 15% increase takes that to roughly $854. An enrollee paying full price would spend more than $1,300 extra over the year.
State averages vary widely. Gaba projects average full-price premiums for 2027 of about $576 a month in Idaho and $1,542 in West Virginia. In Georgia, where regulators finalized a 20.7% average, he estimates that unsubsidized enrollees will pay about $1,925 more a year.
The increases also compound for people just above the subsidy cutoff. KFF follows a 40-year-old in Indianapolis earning $65,000 who was enrolled in a particular Anthem silver plan. That person paid $316 a month in 2025, while enhanced subsidies were still in place. The premium rose to $477 in 2026 and will reach $546 in 2027 if the filed rates are approved, an increase of 41% in two years.
After Arizona, the largest increases are in Alabama (25%, final), New Mexico (24.4%, final), Kansas (24.2%, proposed), Alaska (22.9%, proposed) and Montana (22.6%, final).
Arizona's number may not come down. State law doesn't give Arizona's insurance department the power to approve or reject rate increases, only to judge whether they are reasonable, Arizona Public Media reported.
Washington approved an average 22.2% increase, and Oregon finalized 21.6%. Georgia, one of the largest federal-exchange states, finalized 20.7%. New Jersey's insurers have proposed 20.4%.
Only Vermont (3%), New York (6%), Iowa (6.7%) and Utah (6.7%) come in under 7%. California, the largest state-run exchange, is at 9.9%.
Insurers in New York asked for an average 20.6% increase in the individual market. The state's Department of Financial Services approved 6% and said the cut would save individual-market consumers about $324 million. Eric Linzer, president of the New York Health Plan Association, said the approved rates "fail to fully account" for rising hospital and drug prices.
Connecticut approved an 11.3% average against requests of 16.2%.
In Washington, insurers asked for 22.4% and got 22.2%. Insurance Commissioner Patty Kuderer said state law requires her to approve increases that are actuarially justified. If her office had refused, she said, insurers would "simply just leave the market here," possibly leaving some counties with no carrier.
Oregon went the other way. Regulators raised the average to 21.6%, up from insurers' initial 17.5% request, after new data showed falling enrollment and larger-than-expected losses. The state also added money to its reinsurance program to hold rates down. Maryland insurers raised their requests over the summer; the state's final 14.6% was below the amended filings but above the 13.7% first submitted.
Read next: US insurers face 30% Obamacare premium surge
Insurers arde expecting the underlying cost of care to rise faster than usual. KFF found a median assumed medical and pharmacy cost trend of 10% for 2027, compared with about 8% in recent years.
Carriers cite provider contract increases, hospital staffing costs, spending on GLP-1 drugs and claims billed at higher levels.
And the expiration of the enhanced premium tax credits at the end of 2025 is still feeding through. Healthier, more price-sensitive enrollees were the most likely to drop coverage, which left insurers with a sicker pool. Among insurers that priced that effect explicitly, KFF estimates it added about 4 percentage points to 2026 rates. Many are building in a similar adjustment for 2027.
Enrollment fell 5% to 23.1 million in 2026, and the share of enrollees in bronze plans rose from 30% to 40%, Becker's Payer Issues reported, citing CMS data. Aetna left the exchanges after 2025, displacing about a million enrollees in 17 states. Cigna leaves at the end of this year, taking fewer than 400,000 marketplace customers with it. "We did not make this decision lightly," Brian Evanko told investors when Cigna announced the exit. He has since become the company's CEO.
Subsidies absorb most of the increase, but not above the cliff
Most marketplace buyers don't pay full price. In 2026, 87% of enrollees qualified for a premium subsidy. Subsidies are pegged to the benchmark silver plan in each area, so they generally rise when that plan's premium does.
The share of income subsidized enrollees are expected to pay barely changes. Under IRS Revenue Procedure 2026-26, it ranges from 2.15% to 10.22% of household income in 2027, compared with 2.1% to 9.96% this year.
People earning more than 400% of the federal poverty level get no help at all. For 2027 coverage, that line is about $63,840 for a single person and $132,000 for a family of four in the continental US. Anyone buying off-exchange, where subsidies aren't available, pays the full increase too.
Read next: ACA subsidy expiration changed who benefits brokers are really serving
Auto-renewal carries more risk than usual this year. When the benchmark plan in an area changes, a client's net premium can move quite differently from the headline rate, up or down. Clients whose carrier is leaving the market have until December 31 to choose a new plan if they want coverage to start January 1 without a gap.
Employers are feeling it too. Insurance Business has reported that ICHRA adoption jumped 53% in 2026. Small group premiums face a proposed median increase of about 14% for 2027. Urban Institute modeling suggests millions more workers are moving onto employer plans as individual coverage gets more expensive.
Texas, Florida and California, the three largest marketplaces, have yet to finalize their rates. Gaba says a big change in any one of them could move the national average.
Read next: ACA cuts push more workers to employer health plans
