Those who plan to purchase health insurance through the Affordable Care Act (ACA) or Obamacare during the current enrollment period should prepare for several changes in 2027, including increases in monthly costs and fewer coverage options.
The enrollment period for Obamacare begins Sunday in most states and runs through January 15.
Big changes in the market include expiration of financial assistance, increased fees, possible delays in working with an agent, new restrictions for certain immigrants and stricter enrollment controls.
Financial assistance, including premium tax credits and cost-sharing reductions, is now restricted for many groups of people who were previously eligible.
In general, health experts predict less coverage and higher prices. The average cost of health insurance purchased through the marketplaces is expected to increase 13% in 2027, according to an analysis of new data from the Centers for Medicare & Medicaid Services (CMS) by health research nonprofit KFF.
The increases are due to multiple factors
Cynthia Cox, vice president and ACA program director at KFF, said the increase is primarily due to rising health care costs, hospital market concentration and potential factors such as the No Surprises Act, which went into effect in 2022 and prohibits surprise billing, or the increasing availability of GLP-1 drugs.
The people who will be most affected by the new increases are those who do not qualify for a subsidy.
“They may or may not be able to afford to keep their coverage next year,” Cox said, adding that “many of them have already switched to the Bronze plans, which are the cheapest.”
A CMS fact sheet on open enrollment, distributed Friday, stated that “Americans using HealthCare.gov will have broad access to low-cost plans.”
The price of ACA insurance has skyrocketed for many people during Trump’s second term, after Republicans opposed extending COVID-19-era subsidies that had helped offset health insurance costs for most enrollees during Democratic President Joe Biden’s administration.
This caused 1.2 million fewer people to enroll in the insurance markets.
Almost 20 million beneficiaries
As of February, approximately 19.2 million people in the United States were actively enrolled in ACA marketplace health plans, according to the Department of Health and Human Services (HHS) website. Enrollment grew during the COVID-19 pandemic when enhanced subsidies were made available through the American Rescue Plan Act and the Inflation Reduction Act, both signed into law by Biden.
New regulations taking effect starting in 2027 will also limit tax credits for certain immigrants who are in the country legally, which could result in an additional one million uninsured people over time.
Meanwhile, Donald Trump’s administration has been disenrolling people enrolled in the ACA as part of the ongoing campaign against what it calls waste, fraud and abuse.
In September, Vice President JD Vance and other Republican administration officials announced plans to remove 760,000 ACA enrollees from the public health exchanges, alleging that they had fraudulently enrolled in the program or simply did not exist.
Vance said the discovery and cancellation of subsidy payments for hundreds of thousands of people in the health markets, as part of an Administration-wide campaign against fraud, would generate savings of $2.2 billion.
It’s unclear how many more people will lose ACA coverage in 2027, Cox said. But with higher premiums, changes in immigrant eligibility requirements and anti-fraud measures, “I think there will be fewer people enrolled in this market, but it will be harder to understand why.”
