Why payers have raised prices for ACA marketplace plans in 2027

Insurers have exited markets and hiked premiums for 2027 Affordable Care Act (ACA) Marketplace plans following a drop of about 3 million effectuated enrollees earlier this year.

Payers say they’re raising ACA premiums in part because many of the enrollees who left the marketplace were on the healthier side. Remaining enrollees are sicker, and thus, costlier, and payers expect that trend to continue.

An October analysis by actuarial firm Wakely found that as enrollment dropped from January to July 2026, overall member acuity worsened compared to the same six months in 2025, though it varied by state. The analysis predicts “attrition, especially among healthier enrollees, is expected to continue as the year progresses.”

At the same time, payers are continuing to grapple with high medical costs in other businesses due to factors like rising specialty drug utilization. They’re pulling out of Medicare Advantage and Medicaid markets in the face of rising costs as well.

The effect. Health research and polling organization KFF reported payers raised premiums for 2027 by an average of 13% for second-lowest-cost ACA silver plans, also called benchmark plans because these costs are used to calculate each enrollee’s premium subsidies. It’s less than some premium hike estimates of more than 20% for 2026 plans, but still a double-digit increase.

In addition, as of Oct. 28, 11 carriers are exiting some or all state marketplaces in 2027, KFF found in a separate analysis.

Cigna announced in April it would stop offering exchange plans altogether in 2027. The company had 355,000 on-exchange members across 11 states at the end of 2025, per financial documents.

Other payers, like Centene, are exiting some states but expanding in other places. Centene’s Ambetter Health is leaving Delaware and New Hampshire, though an Oct. 20 press release emphasizes it’s entering 55 new counties as well, and it’s introducing and expanding plans that are tailored to specific conditions like diabetes or congestive heart failure. The payer had 3.4 million marketplace members as of Sept. 30, down from 5.8 million the same time last year.

The cause. Experts and payers attribute these enrollment drops, and payers’ responses, in part to the Jan. 1 expiration of enhanced premium tax credits. KFF estimated in September 2025 that the expiration would more than double what subsidized enrollees pay each year from an average of $888 in 2025 to $1,904 in 2026.

“Marketplace enrollees are paying substantially more than they would have if the credits were extended, and many have dropped their coverage in response,” Matthew Fiedler, senior fellow at nonprofit research organization Brookings Institution, told Healthcare Brew over email.

This upcoming year’s premium increases “appear to partly reflect ongoing deterioration in the individual market risk pool due to expiration of the enhanced premium tax credits (among other factors),” Fiedler said.

Centene increased its prices for the second year in a row for 2027 due to the medical trends it’s already seeing, plus “the expectation for additional acuity shifts” as the market contracts further, Centene CEO Sarah London said during an Oct. 27 earnings call.

Program integrity measures to curb fraud, waste, and abuse are also cutting down enrollments, though London noted the payer’s reserves “sufficiently accounted for the revenue and risk adjustment impact of this activity in the quarter” and said the company believes its guidance “similarly” reflects “the trailing effects of these efforts through the end of the year.”

In a June 2026 report, the Department of Health and Human Services (HHS) attributed 2026 enrollment drops to a crackdown on fraud. The federal government recently cut 760,000 suspected fraudulent enrollees from ACA rolls, though anonymous sources reportedly told KFF Health News that the Centers for Medicare and Medicaid Services has since added back an undisclosed “small number” of people whose coverage should not have been canceled.

“Relative to expiration of the [enhanced premium tax credits], our view was that there would be the most significant shift in 2026, but some degree of tail into 2027, just in terms of the program integrity measures really sort of readjusting the baseline of membership,” London said on the Oct. 27 call.

Additional changes. Complicating matters further: This year’s open enrollment period is accompanied by a moratorium on broker and agent registrations and new verification requirements, which experts told Healthcare Brew could also shrink enrollment.