The Affordable Care Act marketplace enrollment period for 2027 coverage begins Nov. 1 in most states and runs through Jan. 15, with consumers facing higher premiums, fewer plan options and stricter enrollment requirements.

KFF analysis of new Centers for Medicare & Medicaid Services data projects average marketplace insurance prices will rise 13% in 2027, driven mainly by higher healthcare costs and hospital market concentration; the No Surprises Act and wider access to GLP-1 drugs may also contribute.

People who do not qualify for subsidies are expected to feel the increases most sharply, and some may be unable to afford coverage; many have already moved to cheaper bronze plans.

Financial assistance, including premium tax credits and cost-sharing reductions, is now restricted for many people who were previously eligible after Republicans opposed extending pandemic-era subsidies; new rules in 2027 will also limit tax credits for some lawfully present immigrants and could eventually leave another 1 million people uninsured.

The Trump administration says it is removing 760,000 marketplace enrollees it alleges were fraudulently enrolled or did not exist, claiming canceled subsidy payments will save $2.2 billion; JD Vance announced the plan with other administration officials.

About 19.2 million people were actively enrolled in ACA marketplace plans as of February, following enrollment growth during the pandemic when enhanced subsidies were available; sign-ups were 1.2 million lower after those subsidies ended.

KFF's Cynthia Cox said it is unclear how many people will leave ACA coverage in 2027, as higher premiums, immigration eligibility changes and anti-fraud efforts may all reduce enrollment and make the reasons for departures difficult to distinguish.