Open enrollment for 2027 health coverage under the Affordable Care Act (ACA) opens today, Sunday, November 1, 2026, in most states — and Americans who buy their own insurance are walking into a second straight year of double-digit price rises. KFF, the nonpartisan health research organisation, said in an analysis published on Friday, October 30, that the finalized average benchmark silver premium for 2027 is up 13% on 2026, after a 26% jump from 2025 to 2026. Taken together, benchmark premiums have risen 42% on average in just two years.
Source: KFF
What the benchmark is, and why it decides what families pay
The benchmark is the second-lowest-cost silver plan in each area, and it matters far beyond its own sticker price because federal premium tax credits are calculated from it. KFF found that insurers had proposed a median increase of 15%, so the finalized 13% average came in slightly lower than asked. The rise is not even across the country: in states that use the HealthCare.gov platform, benchmark silver premiums are increasing 11% for 2027, after a 30% rise last year, while states that run their own enrollment platforms are seeing an average increase of 16%, after roughly 17% last year.
Source: KFF
Why premiums are climbing again
In their rate filings, insurers point first to a higher-than-usual increase in the underlying cost of medical care — a pressure KFF notes is also hitting employer plans, not just the ACA marketplaces. Insurers also cite the expiration of the enhanced premium tax credits at the end of 2025 and the resulting change in who stays insured: when healthier people drop coverage, the remaining risk pool is costlier to cover. KFF's analysis of insurer filings found that insurers estimated those risk-pool changes added about four percentage points on average to premiums in 2026, and they expect a similar additional effect in 2027.
Source: KFF
Who is protected, and who pays the full rise
Most marketplace enrollees still receive a subsidy, and KFF says that will cushion the impact of the increases for them in 2027. The hardest hit are people with incomes above 400% of the federal poverty level, who no longer qualify for premium tax credits at all since the enhanced credits expired and must pay the full cost of coverage. KFF reporting put that 400% cutoff for 2027 coverage at $63,840 for a single person, $86,560 for a couple and $109,280 for a family of three. The federal cap on annual out-of-pocket costs is also rising, to $12,000 for an individual and $24,000 for a family in 2027, from $10,600 and $21,200, according to CMS guidance reported alongside the KFF analysis.
Source: KFF
Enrollment is already shrinking, and the CBO expects it to fall further
The market has been contracting since the enhanced credits ended. During the 2026 open enrollment period, marketplace plan selections fell by 1.2 million from 2025, KFF said. By February 2026, effectuated enrollment — people who paid their premiums and stayed covered — was down 12%, or 2.6 million people, to 19.2 million. Broader individual-market enrollment, including plans bought directly from insurers, fell 18% between January and June 2026, from 25.2 million to 20.5 million people. In its latest projections, the Congressional Budget Office estimated ACA marketplace enrollment would fall from a peak of 22.4 million in 2025 to 13.1 million in 2027.
Source: KFF
Fewer insurers in many counties, as exits outnumber entries
Shoppers in some areas will also have fewer companies to choose from. As of October 29, 2026, 11 carriers had announced plans to exit at least one state for 2027, while seven carriers had announced plans to enter a new state, KFF said. Cigna, for example, is leaving the individual market in all 11 states where it currently participates. KFF warned that insurer exits can reduce competition, narrow provider networks and disrupt coverage for people whose plan disappears. In September 2026, HHS also reported it had cancelled coverage for approximately 760,000 individuals CMS described as 'phantom' enrollees — people a broker or agent may have signed up without their knowledge — and KFF noted reports that some legitimate enrollees were flagged in that sweep and later reinstated.
Source: KFF
Some states are filling the gap themselves, and immigrant eligibility is narrowing
A few states that run their own exchanges are using state money to replace part of the lost federal help. New Mexico went furthest in 2026, fully backfilling the lost federal assistance, and its marketplace enrollment grew while national enrollment fell; the state is continuing the assistance in 2027. California is continuing its state-funded premium subsidies and expanding them to partially backfill lost credits for households between 165% and 200% of the poverty level, while Rhode Island and Virginia have created new state-specific subsidies for 2027. Separately, the 2025 budget reconciliation law limits premium tax credits in 2027 to certain lawfully present immigrants — lawful permanent residents, Cuban and Haitian entrants, and residents under the Compact of Free Association. Refugees, asylees and trafficking victims can still buy marketplace coverage but will no longer be eligible for the credits, a provision the CBO estimates will leave one million more people uninsured by 2035.
Source: KFF
What the administration says shoppers can still find
The Centers for Medicare & Medicaid Services (CMS), which runs HealthCare.gov, struck a different emphasis in its Plan Year 2027 fact sheet, also released on October 30. CMS said more than 75% of Americans who purchase coverage through HealthCare.gov will continue to have access to premiums at or below $50 in 2027, and that people eligible for tax credits will have access to a plan with nearly 90% of the lowest-cost premium paid by the federal government, compared with 85% in 2020. CMS said shoppers will have access to 100 different plans on average, from five to six insurance companies, including an average of 35 HSA-eligible plans, and that the lowest-cost catastrophic plan is nearly 10% cheaper on average than the next lowest-cost plan at other coverage levels. The CMS fact sheet did not publish an average premium change.
Source: CMS
On HealthCare.gov, open enrollment runs from November 1, 2026 through January 15, 2027. Enroll by December 15 for coverage that starts January 1; plans chosen from December 16 to January 15 start February 1. A rule that would have shortened open enrollment to nine weeks was vacated in court, so the January 15 closing date stands. State-run marketplaces set their own deadlines.
Why this lands hard on self-employed and diaspora families — and what happens next
Marketplace coverage is the default option for many self-employed Americans — including owner-operator truck drivers, small shop owners and gig workers who have no employer plan — and for newcomer families who are not yet on a workplace scheme, so a 42% two-year rise in the benchmark is a household-budget decision, not an abstract statistic. With the midterms two days away, on Tuesday, November 3, the price of coverage is also a live campaign issue. What happens next is practical: shoppers should compare plans rather than auto-renew, update their income estimate carefully — because from the 2026 tax year, the old limits on repaying excess premium tax credits have been eliminated — and check whether their state runs its own marketplace with its own subsidies and deadlines. Anyone whose insurer is leaving their state must pick a new plan during this window or risk being mapped to a different network for 2027.