2027 ACA Rate Filings: A Second Straight Double-Digit Year

2027 ACA premium increases are shaping up to hit your clients for a second straight year. Insurers are proposing a median premium increase of 14% for 2027, based on preliminary rate filings across 16 states and DC. Stacked on this year's increases, that means typical premiums could jump by more than a third between 2025 and 2027.

This is the number that will define your fall, and the clients who feel it most are the ones you need to reach first. Here is what the filings say and how to prepare your book.

What the Filings Show

Three drivers show up across the filings, and each one gives you a clean explanation for clients:

First, medical and drug costs. The underlying cost of medical care and prescription drugs rose about 10% for 2027, higher than the 8% average of recent years. Specialty medications and GLP-1 drugs are a meaningful part of that.

Second, a sicker risk pool. When the enhanced premium tax credits expired at the end of 2025, many healthier enrollees dropped coverage rather than pay higher premiums. That left a smaller, sicker, more expensive group behind. Insurers estimate this drove premiums up about 4 percentage points in 2026 and expect another 4-point increase in 2027.

Third, regulatory changes. Insurers cited recent federal changes, including the 2027 Payment Notice and the Marketplace Integrity and Affordability Rule, as adding upward pressure on rates.

Who Gets Hit Hardest

This is the part that shapes your outreach. Most enrollees are largely protected from the full increase because they still qualify for subsidies, though at a lower level than before. The pain concentrates on one group.

People with incomes at 400% or more of the federal poverty level, about $62,600 for a single person in 2026, lost subsidies entirely when the enhanced credits expired. They face the full premium increase with no cushion. These are the same middle-income clients who took the biggest hit in 2026, and now they are looking at another double-digit jump. Small business owners, early retirees, contractors, and families just above the subsidy line all sit in this group.

Why This Matters Even for Subsidized Clients

It would be easy to assume subsidized clients are fine and can coast. They are not automatically fine. Even clients who keep their subsidy may need to shop around and switch plans during open enrollment to keep their premium roughly level. If they auto-renew without review, they could end up paying more than they need to.

That makes the fall a full-book conversation, not a targeted one. Every client benefits from a proactive review, and the ones above the subsidy cliff need it urgently.

How to Prepare Your Book

Here is a practical approach before AEP opens in the fall.

1. Flag your unsubsidized clients now. Anyone above 400% FPL is facing the full increase. Build that list first and plan to reach them early.

2. Prepare the alternatives. For clients facing a big jump, have options ready: a lower metal tier, an HSA-eligible Bronze plan, an off-exchange option, or a subsidy recheck if their income changed.

3. Plan a full-book review. Even subsidized clients may need to switch plans to hold their premium steady. Build review into your AEP workflow rather than letting people auto-renew blind.

4. Set expectations early. Clients who hear about the increases from the news will be anxious. Reaching out first, with a plan, turns a scary headline into a manageable conversation.

ACA insurers are proposing a median 14% premium increase for 2027, a second straight double-digit year that could push typical premiums up by more than a third since 2025. Subsidized clients are partly cushioned but may still need to switch plans. Unsubsidized clients above 400% FPL face the full hit. The agents who prepare their books now, flag the at-risk clients, and reach out before AEP will keep more of their clients covered and their renewals intact.

Disclaimer: This post is for educational purposes only and reflects information available at the time of publication.