With the opening of the Affordable Care Act enrollment period on Nov. 1, Obamacare enrollees encountered higher prices and started trying to make the best of the situation. We heard from people who were choosing a higher deductible, contemplating switching from silver to gold, and even thinking about dropping insurance altogether.
The news came right before the results of the election started a round of speculation that the incoming Democratic Congress will be able to reverse the higher prices — although President Donald Trump can veto any legislation that might do that.
As open enrollment begins, the average price of Obamacare health insurance will rise by an average 13 percent next year, according to an analysis by KFF, the health research group.
The Trump administration published the new 2027 prices right before the election. These newly published prices are what KFF used to make its calculation that 2027 would be the second year of double-digit price increases, after last year’s expiration of Covid-era subsidies and the resulting 26% average price increase for 2026. Before the subsidies expired, benchmark premiums had grown only about 2% a year for five years.
Democrats’ plans
Will the election results change anything? It remains to be seen. The Democratic leadership in the new Congress – which will be sworn in Jan. 3, 2027 – has said that restoring the Affordable Care Act premium tax subsidies that expired, and stopping the cuts to the Medicaid program for low-income Americans, are top priorities.
It is likely that the hugely powerful insurance industry will support both of these changes, since they both result in more business for insurers. There has been speculation that an A.C.A. reversal could pass and could even be retroactive – but all things take time. And any legislation also faces the possibility of a Trump veto. There has also been speculation that this and the Medicaid rollback could be included in legislation that Trump wants, reducing the chances of a veto. It’s also not clear how either one of those measures would be funded, raising more questions.
For now, for the current open enrollment period, the A.C.A. rates are what’s listed on healthcare.gov. In this open enrollment period, Dec. 15 is the last day to enroll or change a plan for coverage starting Jan. 1; people can still enroll through Jan. 15 for plans starting Feb. 1. Open enrollment ends that day. (Some state-based exchanges have different dates.)
Employer-sponsored insurance is also expected to go up. And premiums for Medicare, which covers disabled and older Americans, are also going up.
‘Insane cost increases’
Regarding her A.C.A. renewal, a 61-year-old North Carolina woman wrote on Facebook: “ACA plans/prices just posted today. Insane cost increases. My premiums had already more than doubled last year and they’ve nearly doubled again. So from 2025 to 2027, my premiums have quadrupled. I’m lucky that I can absorb the increases but I’m so angry that we’ve made healthcare so ridiculously out of reach for most people in order to generate obscene profits for a few. Thanks, Republicans. Your greed will be your downfall and it can’t come soon enough.”
In response to my query about what plan she had and what were the actual prices, she wrote:
“Silver. I’ve been on the same plan (or whatever was the replacement if they didn’t offer exactly the same plan each year). My cost after subsidies 2025: $224; 2026: $503; 2027: $938. I’ll probably switch to bronze this year to get it back down to a reasonable level.”
Most people with A.C.A. plans can count on getting a subsidy based on income, but those subsidies dropped when Covid-era subsidies expired. That caused millions of people to drop out of the market.
Small business suffers
An Ohio woman wrote: “I am in Ohio and self-employed. In 2025 my insurance was around $660 with the subsidy. I would have been around $900 without. In 2026, after the subsidies expired, my insurance jumped to $1200. I was recently notified that my 2027 premium is going to be $1600. This is for a bronze plan. All three plans have been bronze. This is with United.”
Self-employed people, entrepreneurs and the like are being slammed by these increases.
She wrote: “Which is ironic from the party that claims to be the champion of the small business owner. … So I will have to go with an even higher deductible plan to try to get my insurance back down to the 2026 rate. Ohio has United and Blue Cross and Blue shield, and then a bunch of insurers that I have never heard of, and I don’t feel comfortable choosing.”
A California woman wrote: “I have a platinum plan because I can deduct premiums and I usually would reach my deductible limit. I jumped $400 per month to $2,800. At this rate, I’ll be paying $6,000 per month when I reach Medicare age.”
She added: “I have to get my insurance through the Covered California portal because I am a partner in a business that does not provide insurance for the partnership. I do elect to buy a platinum plan because I am able to deduct the expense. So at the end of the day, my actual cost for premiums will be a bit lower and I pay no deductible. (I do pay co-pays and am only covered for certain percentages of some expenses like most other plans.)”
To $726 from $508
A 50-something woman from Iowa wrote that monthly premiums for the A.C.A. plan for her and her husband would go to $725.72 in 2027 from $507.98 in 2026, according to an estimate cited in an A.C.A. mailing. The mailing said the estimate could still change. This is a Gold HMO plan with a $4,000 deductible and out-of-pocket maximum of $16,400 family. “Sticking with the same plan the deductible will go up to $5000/$17,200,” she wrote.
A Minnesota man wrote: “My ACA Bronze plan would go up 30% from 589 to 767 for this 53 year old male. Basically a major medical policy with 8500 deductible / 8500 out of pocket max. I think last year it went from like 500 to 589, but I couldn’t swear to it.”
An Arizona woman wrote: “I have been priced out of the marketplace and am left looking for catastrophic coverage only. A decent plan is well over $1,000 a month. That covers one person with no dependents. The cost of a good plan is equivalent to my mortgage! How long can this go on before it just falls off a cliff?”
To $1,320 from $1,111
A 62-year-old woman in Minnesota wrote: “My ACA plan is going from $1111/mo to $1320/mo ($3400 deductible). Since I have [psoriatic arthritis] this means my health care MINIMUM total per year will go from $16732 to $19240 because of course I will hit my deductible by March. I should receive a couple hundred dollars a month in [advanced premium tax credits] as long as we restrict our income from IRA to be under the cliff.
“My husband is a 66yo male in Minnesota on Medicare. His Part B premium will go from $202.90 to $209.50/mo and his Medigap plan will go from $56/mo to $59/mo – so comparatively a miniscule increase!”
One woman wrote: “I don’t dare look. I’m on cobra from a longterm contract, and you know things are messed up when cobra is the best option. I dread, dread, dread shopping for insurance when my eligibility ends in mid 2027. And my rage at congress knows no bounds.”
Employer rates
Employer-sponsored insurance is going up too. “Annual premiums for employer-sponsored family health coverage reached $28,303 this year, 5% higher than in 2025,” KFF wrote in its annual employer benefits survey. “On average, covered workers contributed $7,471 toward the cost of family coverage. The average deductible among covered workers in a plan with a general annual deductible was $1,955 for single coverage.”
The news is not all bad: A woman who works for one of the Big Four accounting firms wrote to me that there is no change in her employer-sponsored insurance from 2026 to 2027.
KFF continued: “Coverage rates remain stable. Among workers in all firms, including those that offer and those that do not offer health benefits, 55% are covered by health benefits offered by their employer, similar to the percentage last year (55%). Sixty‑six percent of small firms and 98% of large firms offer health benefits to at least some workers, with an overall offer rate of 67%.
“Some large firms responded to projected cost increases by increasing workers’ premium
contributions or cost sharing. Among large firms offering health benefits, 44% increased the share of premiums paid by workers, and 21% increased deductibles or other cost sharing for most services. In 2026, covered workers contribute an average of 18% of the premium for single coverage and 27% for family coverage.
“Average deductible nears $2,000. Among workers who face an annual deductible for single coverage, the average this year stands at $1,955, compared to $1,886 in 2025. Covered workers at small firms face much larger average deductibles than workers at larger firms ($2,624 vs. $1,772).”
Underlying causes
The underlying causes of insurance price increases have not changed. Rising prices for all sorts of medical treatment, from hospital visits to prescriptions, are at the base of these increases. It’s also true that as relatively healthy people decide to drop insurance, as many did when Affordable Care Act subsidies ended last year, the pool of people who are insured tends to be relatively sicker and older, because healthy people are more able to abandon insurance. That means that insurance companies want to raise prices to cover those sicker Americans. (About 1.6 million enrollees earning more than 400% of the poverty level lost their subsidies entirely last year.)
Some industry experts point to the rising use of GLP-1 weight-loss drugs as a cause also, but that is debated.
And as always, the insurance companies, Big Pharma, hospitals, doctors and other healthcare market participants all want to make money. There’s never any pressure for prices to go down. An increasing trend is industry consolidation: Insurers buy physician groups and pharmacy benefit middlemen, and thus pay more for the services of their own doctors and middlemen.
Policy changes
A report from the Commonwealth Fund also pointed to major Trump administration changes as a cause of rising prices.
““In 2025, policy changes advanced by the Trump administration and Congress led to the biggest cuts to Medicaid and the ACA marketplaces since the law’s passage,” the report said.
“The combined effects of these changes are expected to drive the number of uninsured people to 37 million by 2036 — about the same as in 2014, when most of the ACA’s changes took effect.”
“The administration has significantly raised out-of-pocket maximums for both marketplace and employer-sponsored health plans,” it added. “The maximum for commercial plans is set to climb yet further in 2027, to $12,000 for an individual and $24,000 for a family in 2027.”
New A.C.A. blow
A little-noticed rule change also changed the equation for A.C.A. enrollees recently, when the administration issued a Federal Register rule requiring that each enrollee be “redetermined” regularly before renewal.
What it means: For years, around 40-50 percent of A.C.A. enrollees have auto-renewed, meaning they don’t go to the marketplace and seek a new plan — they just roll over to the same one for the following year. Under the new rules, before enrollment, each enrollee with any subsidy will need to be verified.
This effectively ends auto-renewal for any enrollee with a subsidy, meaning that people might get kicked off the rolls if they can’t be contacted — if their mailing address has changed, if an email goes astray, if they forget to reply.
While it’s true that most enrollees should not auto-renew — because checking coverage is wise in case of changes — this rule change probably means a lot of people will lose coverage.
