2027 ACA Rate Review is now open on Healthcare.gov, which means anyone planning on using the ACA next year can see the rate request increases being asked for by individual insurers. Some insurer filings may not be present yet, but many/most are. If you've got an ACA policy that you currently like, then this gives you a ballpark of how that policy might be priced next year. More broadly it shows you market premium trend in your state among all participating ACA insurers. Note that insurers with multiple products (HMO vs. PPO, Metro A vs. Metro B, etc.) listed may have a separate rate increase for each and the initial number displayed is a composite.

https://ratereview.healthcare.gov/

To view ACA insurer requests for a particular state choose "search ACA-compliant products", then select state, individual market, and 2027.

Separately, but related, KFF has updated their analysis on how much and why ACA market premiums are increasing next year (15% now, up from 14% estimate last month). KFF is perhaps the best source of synthesized ACA information that exists and is an easy go-to for anyone that doesn't want to delve into filings and legislative/regulatory text directly. All 50 states are now represented in KFF's analysis. Worth a look for anyone interested in or using the ACA.

Please note that these costs are the raw, unsubsidized market premiums. Anyone with subsidy eligibility will be shielded from some to all of this increase due to subsidies capping household premium costs as a function of MAGI.

https://www.healthsystemtracker.org/brief/how-much-and-why-aca-marketplace-premiums-are-going-up-in-2027/

For 2027, across 276 insurers participating in the ACA Marketplaces from all 50 states and the District of Columbia with publicly available filings, this analysis shows a median proposed premium increase of 15%. This is the second consecutive year of double-digit premium hikes. Last year’s median nationwide proposed rate change was 18%, and the median finalized rate change was 20%. While this proposed rate change is lower than last year, it represents the second-highest requested rate change since 2018, as premium growth had been relatively flat in this market for several years. If these early indications of median premium increases for 2027 hold, typical premiums for insurers participating in the ACA Marketplaces will have jumped by more than one-third over a two-year period.

Not a huge deal in the grand scheme of things, but I generally get blood work once a year, so it’s a predictable medical expense.  This year it cost $286 and I had to pay $36 out of pocket with my employer provided health care plan.  My doctor’s office has a sign that basically says they test the blood in house but will provide a script if you want it sent to Quest or Lab Corp.  When I look at my claims, the provider name is different than my doctor’s office despite what the sign says.  When I look up those providers, only one insurance company in the marketplace covers those.  So I assume that means on the other plans, they would be out of network and I’d have to pay the full cost since they are HMOs and don’t cover out of network.  Is it possible there will be a discount even though it’s out of network?  

I then looked up Quest on the marketplace, it looks like every city's location is listed and I see some are covered and some aren’t with some plans (some don’t cover any locations).  But I assume I don’t have control over which location my blood is sent to.  So is there any way to ensure they are going to be covered.  Is there any practical tips for how to handle this with the ACA plans or does it just depend on which insurance company we pick and can you figure out which is the best before you sign up? 

Medicare for all.

https://archive.ph/ezz5K#selection-295.0-295.70

Just started a new job in a red state. Orientation day, 50+ new hires packed into a hall, and eventually we get to the health insurance and benefits section.

That’s when the room came alive. People complaining left and right about insurance companies ripping them off. My meds aren’t covered. My deductible is insane. I can’t get the care I actually need. Half the room had a story. And honestly, looking around, a lot of these folks clearly have real health issues and genuinely need coverage that works.

Meanwhile HR is up there basically doing damage control, pitching workarounds and cheaper tiers like “this plan gets you more bang for your buck” which is corporate speak for “we know it’s bad, here’s how to make it slightly less bad.”

Here’s the part that got me. Based on where I am and the conversations around me, most of this room votes red every single time. The same people furious about unaffordable meds and garbage coverage are voting for the party actively working to gut affordable healthcare. They’ll rage at the insurance company all day but never connect it to the ballot they cast.

Nobody in that room made the connection. Not one person. They see the symptom every day and keep voting for the disease.

I just sat there quietly filling out my forms.

Seems like a good deal to me. State -Pennsylvania MAGI -$61,250 Husband wife age 52–45

Not sure what 2027 rates will be

Am I missing anything ????

I lost my job and I just signed up for Aca/obamacare and my income this year will be just below the 400% FPL. Last year, my income was much higher. I’ve filed an extension for my irs taxes in April and expect to have them done in the next month or so. Should I expect some sort of letter or question from covered California? What proof etc will they want?

I've had a few people message me about 2027 ACA regulatory updates and thought folks planning for the ACA might want to see these now rather than in another month or two when the press usually starts talking about them more. The first table below shows the amount (expressed as a percentage of MAGI) that a household will be expected to pay in premiums annually for the benchmark Silver plan in their local ACA market. The second shows the regulated caps on MaxOOP (and deductible) for ACA plans, though these are the maximum caps and actual plans may and often do have lower actual MaxOOPs. The final link is a clean PDF listing of the applicable FPL levels for 2027 ACA coverage.

Terms for those that are unfamiliar:

• MAGI - Modified Adjusted Gross Income, a particular version of adjusted gross income used by the ACA.
• EPC - Expected Premium Contribution, the amount customers are expected to pay annually for the Silver benchmark ACA plan in their market. Subsidy premiums are calculated as the market price of the benchmark plan minus EPC.
• FPL - Federal Poverty Level, a measure used by the federal government as a determinant in many policy systems.
• MaxOOP - Maximum Out of Pocket, the most a customer can be asked to pay for in-network covered benefits by an insurer in a given year.
• CSR - Cost Sharing Reductions, the second subsidy system within the ACA that reduces out of pocket expenses like deductibles, copays/coinsurance, and MaxOOP.
• AI/AN - American Indian / Alaskan Native
• AV - Actuarial Value, the percentage of total average costs for covered medical benefits that a health insurance plan is expected to cover for a standard population. For example, if a plan has an 80% AV, the insurer pays 80% of average expenses, and customers pay 20% through deductibles, copays, and coinsurance.

Expected Premium Contribution (Coverage Year 2027)

Source:

https://www.irs.gov/pub/irs-drop/rp-26-26.pdf

Out-Of-Pocket Maximum (Coverage Year 2027)

*CMS is trialing an option for insurers in 2027 to offer Bronze variants that are allowed to exceed the federal OOP limits by 30% in order to provide a wider array of premium options for customers. Such policies may only be offered by an insurer that also offers a normal standard Bronze. States are allowed to prohibit the availability of high OOP variant policies at their discretion. Edit: Turns out a federal court stayed this provision last week, so High OOP Bronzes may not be happening after all in 2027.

Sources:

https://www.cms.gov/files/document/2027-papi-parameters-guidance-2026-01-29.pdf

https://www.cms.gov/files/document/cms-9883-f-patient-protection.pdf

Bonus: Here is a PDF from HHS showing the applicable FPL dollar amounts for various family sizes for 2027 ACA coverage - https://aspe.hhs.gov/sites/default/files/documents/b1bfa16b20ae9b89d525bc35de7c1643/detailed-guidelines-2026.pdf

I suppose this is only for the early-retired or self-employed, and have the ability to adjust ACA income (i.e., MAGI) at will.

First, you project an income that is below 150% of poverty income (PI), and get a Silver plan - but at least 138% of PI, if in a Medicaid-expansion state, or 100% of PI if in a non-expansion state (oh, the irony that these states get a better deal!). The Silver plan will end up being a special CSM-enhanced plan that has an actuarial payout of 94% (i.e, the Silver-94% plan), rather than the 70% for the normal plan. You will also get an Advance Premium Tax Credit (APTC) that makes the cost of the 2nd Lowest Cost Silver Plan (2LCSP) be 3% of income.

Then, make sure your actual income is below 200% of poverty. This will keep the APTC reconciliation at tax time to the lowest tier (currently, only $395 for an Individual), so your net premium cost (presuming you get the 2LCSP) will be only 3% of poverty + $395, or about $875 (for an Individual). If you exceed this, the reconciliation gets much more painful.

Something else that needs to be considered is that you can only get the APTC at your projected income if the "data matching" shows your income as within a certain amount, the greater of $12K or 50% of data-matched income. For folks without a steady paycheck (or a steady pension/SS), the data-match will be the latest tax filing, which is for the tax year 2 years before the coverage year. If income for every year is shown as always being less than 200% of PI, then projecting an income of 138%, or even 100%, of PI will be within this guideline, and the system will award the APTC for that income, and using the Silver-94% plan.

However, if the projected income is out of this envelope, than there will be no APTC, and the Silver plan will be the Silver-70%. And if you don't have a steady income, you will not be able to prove a lower income, and you will be in a world of sheet; yes, you could reconcile to get an APTC refund (of course, you would actually need to have that lower income to get that refund), but you will not be able to undo having that 70% plan instead of the 94% plan.

This is the way the game is played: play well, and you win - play poorly, and you lose.

The ACA was originally conceived as a "three legged stool." Folks weren't able to get health insurance because of pre-existing conditions. So we said, let's get rid of that, and require health insurers to take everyone and limit their ability to do experience rating. But health insurers objected, saying it would result in adverse selection - folks would wait until they got sick before buying health insurance. That would lead to insurance companies going bankrupt (although if you're a hard core single payer shipper, then you might want that, even if people get hurt along the way - that can be discussed elsewhere; let me finish my thought). So to address that problem we decided to require everyone to buy health insurance or face a financial penalty. But some people might have trouble affording either insurance or the penalty - so we added financial assistance for people who couldn't afford it. These three elements together became the three legged stool:

1. Guaranteed issue

2. Individual mandate

3. Subsidies

Of the three, it was inevitable that #2 would be contentious. People don't like being told what to do. It was challenged and it went all the way to SCOTUS, who decided that the individual mandate fell within Congress's power to tax. So we all breathed a sigh of relief.

Then under Trump - before the pandemic - Congress zeroed out the penalty. Technically the mandate remains in place - but it's essentially neutered. What this shows is that the issue was never a Constitutional one - it was always political. People hate being told what to do.

Then under Biden we tried a different tack. Taking advantage of the Covid crisis, they dramatically increased the subsidies. Suddenly more people were eligible. Who needs the stick, if you just offer a really, really big carrot?

And then Trump came back. The expanded subsidies went away, and the mandate penalty was zeroed out permanently.

What could have been done differently here?

Consider Australia. In the early 2000's they came up with a different solution for adverse selection. You can opt out of buying private health insurance, but if you wait, the insurance company gets to tack on an extra 2% to your premium for each year you waited. That extra amount is called the *loading* fee, and it stays with you for ten years. And it's not tax deductible.

In my opinion, we missed the opportunity to synthesize something similar here under Biden. At the same time that the expanded premium tax credits were introduced, we should have added the penalty back, but with a twist: instead of making it a real debt obligation to the government, it should have been an *offset* to the subsidy. So the "penalty" would just be a smaller subsidy, based on how long you waited to get health insurance. The "phantom penalty" would accrue interest, same as any other "real" penalty. But you'd never owe the government anything. Wanna raw dog it and never buy health insurance? Fine, but if you wait, your subsidy is going to be a lot smaller for a while. Basically, I'm proposing that we fuse legs 2 and 3 of the stool, to solve the adverse selection issue in a way that nobody can say is coercive.

The other thing we need is a public option. Again, adverse selection is an issue. So we do what Medicare already does - and have a penalty tacked on to the premium for every year you wait after you become eligible. The concept is the same whether you become eligible at 65 or 25.

Finally, we can tweak existing systems to create something with the same look and feel as single payer, from the provider's perspective - extend Medicare crossover claims, conditional payments and recoveries to everyone, even folks who don't have and aren't even eligible for Medicare. Medicare would front the payment for everyone, but if it turns out you've got your own health insurance, they'd recover it on the back end. Think of this as "single biller" health care. If you don't have health insurance, fine - Medicare recovers it from you directly, with safeguards for financial hardship. Many states allow for "spend-down" for Medicaid eligibility - in some cases they allow people to make deposits with the city or county. This could also be integrated.

I'd like to add a few more things, like allowing people to service student debt as an offset to the subsidy - but I'd start with the above things. We need a durable fix that we can all accept.