ACA Premiums Are Going Up Again and Patients are Paying the Price
After 2026 premium hikes pushed millions out of ACA coverage or into higher-deductible plans, insurers are seeking another round of double-digit increases while spending billions on stock buybacks.
By Rachel Madley, PhD
August 12, 2026
Health insurers selling plans on the ACA Marketplaces are proposing another round of double-digit premium increases for next year. Across 276 insurers participating in the Marketplaces, the median proposed increase is 15% for 2027, making this the second consecutive year of double-digit increases.
These increases are being layered on top of an enormous jump that patients have already absorbed in 2026. Insurers initially requested a median 18% increase for 2026. The final median increase was even higher: 20%. If the proposed increases for 2027 hold, typical Marketplace premiums will have increased by more than one-third in just two years. For families already struggling to afford health care, that isn’t an abstract statistic. It can be the difference between having health insurance and going without it.
At the beginning of this year, approximately 23 million Americans selected an ACA Marketplace plan for 2026—more than one million fewer than the year before. Nearly 2 million more dropped out of coverage in the first months of 2026, meaning ACA enrollment decreased by 12% from 2025 to 2026.
The enhanced ACA premium tax credits expired at the end of 2025. At the same time, the underlying price of insurance increased substantially. The average amount Marketplace enrollees actually paid toward their premiums increased 58%, from $113 per month in 2025 to $178 per month in 2026. Many people across the country could not keep up with the rapid increase in health insurance premiums and are now forced to go without it.
Others Are Keeping Insurance But Getting Less Coverage for Their Money
In addition to many families becoming uninsured, we saw a drastic rise in the number of people moving toward being underinsured in 2026. In 2025, 30% of ACA enrollees were in Bronze plans that have high deductibles and out-of-pocket costs. This year, that jumped to 40%, with Bronze enrollment increasing from 7.3 million to 9.2 million people.
Meanwhile, enrollment in Silver plans, which generally have higher premiums but lower cost sharing and can provide particularly valuable cost-sharing reductions to eligible lower-income enrollees, fell from 57% of plan selections to a record-low 43%.
Buying down to Bronze can seem to make sense for someone desperately trying to keep their monthly premium manageable. But the tradeoff comes when they actually need health care. The average ACA Marketplace deductible increased by more than $1,000 per person in a single year, from $2,759 in 2025 to a record $3,786 in 2026, a 37% increase and the steepest increase in Marketplace deductibles on record. This means the affordability crisis isn’t fully captured by the number of people who become uninsured.
For someone living paycheck to paycheck, a health insurance card paired with a deductible of several thousand dollars can still mean delaying a doctor’s visit, putting off a procedure, or worrying about whether you can afford the bill if you get sick. In effect, families confronting higher premiums are increasingly being forced into two bad choices: pay more each month to maintain meaningful coverage, or pay less for a plan that exposes them to thousands of dollars in additional costs when they get sick.
When Patients Get More Expensive, Insurers Raise Prices
Insurers have pointed to a sicker ACA Marketplace population as one reason they need to raise premiums. Insurers estimate that changes in the risk pool added roughly four percentage points to premium increases in 2026 and could add another four percentage points in 2027.
But there is another way to think about what those numbers tell us.
The fundamental business model of a private health insurance company depends on…
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