The 2027 Health Insurance Bill Traces to the 2025 Cliff

ACA marketplace insurers are asking for a 15% median premium increase in 2027, the second straight year of double-digit hikes. Job-based plans and Medicare drug coverage are moving up too, in different wrappers.

Hospital prices, a closed Medicare premium shield, heavier GLP-1 drug use, and the 2025 subsidy cliff are all inside those 2027 numbers. A lot of the job-based hit will show up as deductibles and a larger paycheck share, not as a single new premium line.

Three Coverage Types, Three Versions of the Bill

Larry Levitt, executive vice president for health policy at KFF, a nonpartisan research group, put the common pressure in plain terms. Open enrollment is when the higher bills become impossible to ignore, he said, and that holds for every kind of coverage.

Healthcare costs are going up faster than they have in years, and open enrollment is when the healthcare affordability crisis is really going to hit home for people. That’s true for whatever kind of insurance you have.

Larry Levitt, Executive Vice President for Health Policy, KFF

KFF’s updated filing review, covering 276 insurers in all 50 states and Washington, D.C., found a median 15% premium increase in 2027. That follows an 18% median proposed change for 2026 and a 20% median finalized change. If the 2027 requests hold, typical marketplace premiums will have jumped by more than one-third from 2025 to 2027. The spread is wide: requested changes run from a 1% cut to a 54% increase, 63% of insurers asked for 10% to 25%, and 51 asked for more than 25%.

THE 2027 BILL BY COVERAGE TYPE

Those three rows are not three separate shocks. Insurers in every market are pricing the same hospital, clinic, and drug inflation. The ACA line also carries a leftover from 2025 policy, and the Medicare line carries a program that CMS is closing after 2026.

Last Year’s Subsidy Cliff Is Inside Next Year’s Rates

Rising medical prices remain the main load. In a detailed slice of filings from 16 states and D.C., KFF found a 10% median medical trend for 2027, above the 8% trend of recent years. Moda Health Plan in Oregon told regulators that a 10.2% annualized trend, plus worse-than-expected 2025 claims, added about $78 per member per month.

The individual market then adds a second load. Enhanced premium tax credits expired at the end of 2025. People who could drop coverage did, and the remaining pool is older and sicker on average, which is now part of 2027 pricing.

HOW THE 2025 CREDIT LAPSE SHOWED UP

1. End of 2025: Enhanced premium tax credits expire after Congress does not extend them.
2. 2026 open enrollment: Sign-ups fall. KFF finds adults 18 to 34 account for 46% of the drop in plan selections, 542,000 people, an 8% decline from 6.7 million to 6.2 million.
3. February 2026: Effectuated enrollment, people who paid and kept a plan, falls 13%, from 22.1 million in 2025 to 19.2 million, about 3 million people.
4. Summer 2026: Insurers file 2027 rates citing higher prices and a sicker remaining pool. KFF’s July review of early filings said insurers put the sicker mix at about four percentage points in 2026 rates and expected another four points in 2027.
5. August 2026: Oregon’s Division of Financial Regulation issues final individual-market orders. Oregon approved a 21.6% average increase, well above the national 15% median of still-proposed rates.

Some households already lived the cliff in 2026, with monthly bills that more than tripled on the same metal tier once the extra credit vanished. That is the mechanism inside 2027 pricing: the people who could leave did, and the people who stayed need more care.

Young Adults Drove Nearly Half the Sign-Up Drop

KFF still finds that 87% of 2026 marketplace sign-ups receive some premium subsidy, so many lower-income enrollees are partly shielded from the full 15% request. The people who lost the most help are those just above four times the federal poverty level, who lost the extra credits entirely.

Take KFF’s worked example: a 40-year-old in Indianapolis on Anthem Heart Healthy Silver Essential 4500, earning $65,000. With the extra credits, the 2025 payment was $316 a month, while the unsubsidized premium would have been $388. The 2026 payment rose to $477 after the credits expired. If 2027 rates are approved as filed, it reaches $546. From the $388 unsubsidized 2025 premium to $546 is $158 a month, or 41%, in two years.

A separate case in circulating enrollment notes is an $80,000 earner who does not qualify for standard subsidies. The cheapest bronze plan can rise by roughly $80 a month, or $960 over a year. New Mexico is the exception KFF flags: it was the only state that fully replaced the expired federal credits with state money, and it was the only state that did not lose marketplace enrollment.

As of September 15, 2026, KFF was tracking nine carriers leaving some or all of their ACA markets for 2027 and six entering new ones. Cigna is leaving the individual market in the 11 states where it sold on- and off-exchange plans, after reporting first-quarter on-exchange enrollment above 350,000. Fewer carriers and a sicker pool is the same spiral economists have described for years, now visible in 2027 rate binders.

Look Past the Premium During Open Enrollment

Most people with insurance get it at work. Marsh, the benefits consultant, surveyed more than 1,800 employers and found total health benefit cost per worker will rise 8.2% on average in 2027, the largest increase since 2003, even after planned cuts. With no changes, employers said the same plans would cost 11% more. The 2026 figure was 6.7%. Marsh calls 2027 the fifth straight year of elevated growth after a decade of milder increases, and the highest of those five years.

Dr. Kevin Schulman, a professor of medicine at the Stanford University School of Medicine who studies job-based coverage, said an 8.2% employer bill does not automatically become an 8.2% worker premium. Employers still pay most of the premium. When the total jumps this fast, they have other levers, including slower raises.

“Because the costs are going up, the employers are trying to reduce the rate of growth, and the easiest way to reduce the rate of growth of healthcare costs is to push more of the costs onto the employee,” Schulman said.

Simon Camaj, Marsh’s U.S. Health and Benefits leader, said few firms can eat health-cost growth that outruns inflation without hard budget choices. A Marsh survey earlier in 2026 found about two-thirds of large employers, those with 500 or more workers, expect to raise the employee share of premiums. In the national survey, 59% of employers plan cost-cutting changes for 2027, including higher deductibles.

HOW EMPLOYERS PLAN TO SHIFT THE COST

• Paycheck share: About two-thirds of large employers expect to raise what workers contribute toward premiums, so many deductions will rise faster than the 8.2% average.
• Deductibles: 59% of employers plan cuts that include plan-design changes such as higher deductibles, which raise what people pay when they use care.
• Wages: Schulman said some firms slow raises to offset the benefit bill, a cut that never appears on the insurance card.
• New plan types: 12% of large employers, and 18% of those with 20,000 or more workers, plan to offer variable copay plans that charge less for certain high-performing doctors and often keep a low deductible.

Marsh says more than a third of large employers plan to offer some non-traditional medical plan in 2027, such as a variable copay or high-performance network option. A cheaper-looking paycheck deduction can still cost more at the doctor if the deductible moved. That is the version of this bill most workers will see first, and it is easy to miss if open enrollment is only a premium comparison.

Medicare Ends the Part D Premium Shield

Monthly Medicare bills split. Part B covers doctor visits and outpatient care. Part D covers drugs. CMS said the 2027 pressure is concentrated in Part D, where a temporary federal program that held down standalone drug-plan premiums is going away.

On July 28, 2026, CMS released 2027 bid figures and said it would end the Part D stabilization demo after 2026. The agency said plan sponsors now have enough experience under the Inflation Reduction Act’s redesigned drug benefit to price bids without that extra support, and that the program will return to ordinary market rules in 2027.

THE 2027 PART D BASELINE

• Base premium: The national base beneficiary premium, a formula input, not a universal bill, rises from $38.99 to $41.33, a 6% increase, the maximum the Inflation Reduction Act allows each year through 2029.
• Average bid: The national average monthly bid amount is $296.05, the enrollment-weighted average of basic-benefit bids used to set the federal subsidy.
• Yearly cap: Enrollees still have a $2,400 yearly Part D spending cap in 2027.
• Program end: The Part D Premium Stabilization Demonstration, started in 2025 for standalone drug plans, stops at the end of 2026.

Miranda Yaver, an assistant professor of health policy and management at the University of Pittsburgh, said drug premiums are where enrollees may see the biggest change, and that the program had cut the average premium by 40% the prior year. The Government Accountability Office found that without it, monthly premiums would have nearly doubled. People on Medicare are often retired and live on fixed incomes, she said, and more of them may shop into thinner plans.

WHERE EXPERTS DISAGREE

• CMS: 2027 bids show sponsors can price the redesigned benefit without the extra program, so the agency is closing it and returning Part D to ordinary market rules.
• Yaver: Ending the shield will still raise what many retirees pay, and some will move into lower-quality drug plans that leave them less protected.

What any one person pays still depends on income and the specific plan. The $41.33 figure is a starting point for basic-premium math, not a promise that every Part D card will print that amount.

A $500 Refund Meets a Much Larger Tab

On September 10, 2026, the White House said it would send $500 refunds to nearly 1 million people in the 30 states that use HealthCare.gov. The checks are framed as a return of unused federal exchange user fees charged under the prior administration and passed through in premiums. They go to people who do not receive premium assistance. Distribution is set to begin in October 2026.

President Donald J. Trump announces $500 rebate checks to nearly 1 million hardworking Americans who were wrongly overcharged through Obamacare.

"Our Administration is doing the right thing and giving the money back to the people who were wrongly ripped off." pic.twitter.com/XWA1wlzRH8

— The White House (@WhiteHouse) September 10, 2026

President Trump said the administration is “giving the money back to the people who were wrongly ripped off.” The fact sheet lists Alabama through Wyoming among the 30 federal-exchange states and excludes anyone still getting a premium tax credit, plus residents of state-run marketplaces.

The $500 check pales in comparison to the increased premiums that marketplace enrollees are facing due to the expiration of the enhanced subsidies.

Miranda Yaver, Assistant Professor of Health Policy and Management, University of Pittsburgh

For the $80,000 bronze example, $500 covers a little more than half of one $960 annual raise, and only if that person is unsubsidized, lives in a HealthCare.gov state, and is on the list. It does not change 2027 rates, restore the expired credits, or reach the 19.2 million people still in marketplace plans. The timing, weeks before fall enrollment for 2027 coverage, puts a one-time check next to a recurring premium.

Weight-Loss Drugs Add a Full Point to Employer Trend

Sunit Patel, Marsh’s U.S. chief actuary for health and benefits, said several older pressures still sit under the 8.2% figure: costlier new tests and drugs, hospital consolidation, and higher charges to employer plans when public programs pay less. Newer items pushed 2027 above anything Marsh has logged since 2003. At the top of that list are GLP-1 drugs for weight management.

“Still, we estimate that rising GLP-1 utilization accounts for a full percentage point of the overall cost growth for 2027,” Patel said. Some employers dropping the benefit for 2027 are chasing short-term relief, he added, while the market for the drugs is still shifting. Levitt said ACA insurers have felt pressure to cover GLP-1s for weight loss and are seeing large cost increases for those drugs. That same class of medicines is already colliding with Medicare’s limited GLP-1 coverage, which leaves many patients outside the federal deal and on commercial plans that then price the claims into 2027 premiums.

Marsh also flagged AI billing tools that help clinics file more claims, and at higher billing levels, plus larger-than-expected payments to out-of-network providers through the Independent Dispute Resolution process created under the No Surprises Act. Those items do not show up on a worker’s enrollment screen as “GLP-1” or “billing software.” They show up as an 8.2% employer budget line and then as a deductible.

ACA shoppers will see 2027 prices when marketplace open enrollment opens for 2027 plans. CMS said it would publish the 2027 Medicare Advantage and Part D landscape, with final average premiums, in mid-to-late September 2026. Workers should read the deductible and the paycheck share, not only the premium, because that is where Marsh says a majority of employers plan to recut the plan.

Disclaimer: This article is news reporting and analysis of published rate filings, employer surveys, and federal announcements. It is informational only and is not insurance, tax, medical, or benefits advice. It does not recommend that any person enroll in, drop, or switch a health plan, accept or refuse a rebate, or change Medicare Part D coverage. Readers should consult a licensed insurance broker, a benefits administrator, or a Medicare counselor, and a tax professional if subsidies or refunds are involved, before acting on 2027 coverage choices. Figures and program statuses reflect the filings, surveys, and agency notices cited here, including proposed rates that state regulators may still change, and those numbers can move before open enrollment closes.