ACA premiums are rising for 2027: how to budget before open enrollment

Insurers selling Affordable Care Act marketplace plans proposed a median premium increase of about 15% for 2027, the second year in a row of double-digit increases, according to KFF's analysis as summarized by healthinsurance.org in an update on October 19, 2026. The range is wide: Vermont finalized about 3%, while Arizona's proposed average is 29%. Washington finalized 22.2%, and New York 6%.

A 15% rise on the sticker price is not the same as a 15% rise in what you pay. Most marketplace enrollees get a subsidy, and the subsidy moves too. This guide explains who feels the increase, how to estimate your own number before the renewal arrives, and how to fit it into your budget. Dollar examples are fictional.

Why are ACA premiums going up in 2027?

Insurers point to several causes at once:

• Medical costs: higher hospital prices, drug spending including GLP-1 medicines, and more use of care.
• A smaller, sicker pool: the enhanced subsidies expired at the end of 2025, healthier people have been leaving the market, and that raises the average cost of those who stay.
• Federal rule changes: several new marketplace rules took effect, although courts have blocked some provisions.

Final rates were approved in about two-thirds of states by mid-October, so your own plan's price may still differ from the proposed figures.

Will your health insurance cost 15% more?

Probably not exactly. It depends on whether you get a subsidy and which plan you have.

The premium tax credit is set so that you pay a fixed share of your income for the benchmark plan, the second-lowest-cost silver plan in your area. For 2027 that share ranges from 2.15% to 10.22% of household income, up slightly from 2.1% to 9.96% in 2026. When the benchmark gets more expensive, the subsidy grows to cover the difference. When your plan rises faster than the benchmark, you pay the gap.

In the first two rows, the person's expected contribution is $300 a month, so the subsidy grows from $300 to $390 when the benchmark rises from $600 to $690. The slightly higher 2027 percentages, or a change in income, can move that contribution a little.

The people who pay the full increase are those with no subsidy: households above 400% of the federal poverty level, and anyone who buys a plan directly from an insurer outside the marketplace, where subsidies are not available. For them, the percentage on the rate filing is close to what they will pay.

When is open enrollment for 2027 coverage?

Open enrollment for marketplace plans runs from November 1, 2026 to January 15, 2027 on HealthCare.gov, according to the National Association of Insurance Commissioners. To have coverage from January 1, you need to apply and choose a plan by December 15, 2026. Some state-run marketplaces set different dates, so check yours.

If you do nothing, the marketplace usually renews you into the same or a similar plan at the new price. Auto-renewal is convenient, but it is also how people end up on a plan that is no longer their best option, because the cheapest plans change from year to year.

How do you compare plans by total cost?

Look at what the year would cost you, not just the monthly premium. For each plan you are considering:

1. Premium for the year: your monthly net premium times 12.
2. Expected care: what you would pay in a normal year at that plan's deductible, copays, and prescriptions. Use last year's visits and medicines as a guide.
3. A bad year: the plan's out-of-pocket maximum plus the yearly premium. That is the most the year could cost.

A plan with a low premium and a high deductible can be the cheapest in a healthy year and the most expensive in a bad one. Seeing both numbers side by side makes the choice clearer. Check that your doctors and prescriptions are still covered, because plan networks and drug lists change each year too.

Also update your income estimate. Subsidies paid in advance are reconciled on your tax return, and if your income turns out higher than estimated, you may have to repay part of the subsidy.

How do you fit a higher premium into your budget?

1. Change the premium line in January, using the net amount from your enrollment confirmation.
2. Set up a deductible fund. Divide the amount you expect to pay in deductibles and copays by 12 and set it aside each month, a sinking fund for care.
3. Find the difference somewhere specific. If the premium rises $64 a month, name the category that gives it up, rather than hoping it works out.
4. Check your emergency fund. If a bad year could cost several thousand dollars, make sure your emergency fund could cover the out-of-pocket maximum.

Self-employed people and early retirees feel these increases most, because they pay the whole premium themselves. If that is you, keeping business and personal money apart also makes the income estimate for your subsidy easier to get right. If someone in your household also collects Social Security, the 2027 COLA guide shows how much of next year's raise reaches your budget.

In Nethaven, you can record the premium as a recurring expense with its due date and give it a line in your budget, so the new amount is visible in every month's plan, not only in January.

Premium figures from KFF and state rate filings as summarized by healthinsurance.org, updated October 19, 2026. Open enrollment dates from the NAIC, October 20, 2026. Both checked October 23, 2026. Proposed rates may change before open enrollment. Plan prices in the table are fictional.