Millions of Americans shopping for health insurance through the Affordable Care Act (ACA) marketplace face a more expensive and complicated enrolment period as coverage selection for 2027 gets underway.

Average benchmark silver premiums in the Affordable Care Act marketplace are expected to increase by 13% in 2027, according to an analysis of federal data by healthcare research organisation KFF. The increase comes alongside changes to financial assistance, eligibility requirements and enrolment checks that could make it harder for some people to maintain affordable coverage.

The open-enrollment period began on 1 November in most states and runs through 15 January, 2027. The marketplace, also known as Obamacare, allows individuals and families to compare insurance plans and access financial assistance if they qualify.

Why Are Affordable Care Act Premiums Increasing?

Several factors are contributing to higher insurance costs, including rising healthcare expenses and hospital market concentration.

Cynthia Cox, vice president and director of KFF's ACA programme, also identified the potential influence of GLP-1 medications and the No Surprises Act, which was introduced in 2022 to protect patients from unexpected out-of-network medical bills.

However, the expiration of enhanced premium tax credits has become another significant concern.

These additional subsidies, introduced during the COVID-19 pandemic, helped reduce monthly insurance costs for millions of Americans. Their expiration means many households will receive less financial assistance than they previously did.

People who do not qualify for subsidies could face particularly steep increases, potentially forcing some to switch to cheaper bronze plans or drop their coverage altogether.

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Who Could Lose Affordable Care Act Coverage?

The changes could affect some of the nearly 19.2 million Americans who were actively enrolled in ACA marketplace plans as of February 2026.

New eligibility restrictions will also limit access to premium tax credits for certain lawfully present immigrants, including refugees and asylum seekers. Although these groups may still purchase marketplace insurance, they will no longer qualify for the same federal financial assistance.

The Congressional Budget Office estimates that this restriction could leave an additional one million people uninsured by 2035.

Meanwhile, the Trump administration has intensified efforts to identify fraudulent marketplace enrolments. In September, the Department of Health and Human Services announced that coverage had been cancelled for approximately 760,000 individuals across 315,000 policies, whom officials identified as potentially unauthorised or 'phantom' enrollees.

KFF reported that some enrollees had their coverage reinstated, raising concerns that the criteria used to identify potentially fraudulent registrations may also have flagged legitimate policyholder

What Other Changes Should Enrollees Expect in 2027?

Consumers could encounter additional identity and enrolment checks, while some may face delays when seeking assistance from insurance brokers. However, litigation has temporarily halted the implementation of several proposed marketplace requirements for 2027.

Federal officials have temporarily paused registration for agents and brokers seeking to join federally facilitated marketplaces, including state-based exchanges operating on the federal platform, if they did not have an active 2026 Exchange Agreement. The restriction is scheduled to remain in place until 1 February 2027, potentially limiting access to professional enrolment support.

Another important change concerns premium tax credit repayments. Beginning with the 2026 tax year, previous limits on how much certain people must repay after receiving excessive advance subsidies have been eliminated.

Consequently, people whose actual annual income exceeds their estimates could face larger tax bills. Updating income information during the year will therefore be particularly important.

What Should Americans Do Before Choosing a Plan?

Consumers should compare available plans carefully rather than automatically renewing existing coverage. Monthly premiums are only one consideration; deductibles, out-of-pocket costs, prescription coverage and access to preferred healthcare providers also matter.

Those receiving financial assistance should check whether their eligibility or estimated subsidy has changed and ensure their income information is accurate.

Despite the changes, the Centers for Medicare and Medicaid Services says more than 75% of people purchasing coverage through HealthCare.gov will continue to have access to plans with monthly premiums of $50 or less in 2027.

Understanding the changes before selecting coverage could help households avoid unexpected expenses and make more informed healthcare decisions.

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