Health insurers selling individual coverage on the Affordable Care Act marketplace are asking for a median premium increase of 15% for 2027, according to a Peterson-KFF Health System Tracker analysis updated August 3 that now covers proposed filings from 276 insurers in all 50 states and the District of Columbia. It would be the second consecutive year of double-digit increases — and for the roughly 3.3 million Texans who actually hold marketplace coverage, the third straight year of paying noticeably more for the same insurance.
The stakes are simple: if the proposals hold, Peterson-KFF calculates that typical marketplace premiums will have jumped by more than one-third in just two years. Last year insurers proposed a median 18% increase and state regulators ultimately approved a median of 20%. This year’s requests range from a 1% cut — proposed by a single insurer — to a 54% increase, with 51 insurers asking for more than 25%.
When The Texas Dispatch covered the early filings in July, the median stood at 14% across a 77-insurer subset; the full national picture is now in. The filings are preliminary; regulators can trim them before rates are finalized in late summer, and the Texas Department of Insurance reviews the filings for plans sold in this state.
Texas has more residents on the federal marketplace than any other state. A record 4.17 million Texans selected a 2026 plan during open enrollment, about 5% more than the year before, according to Texas 2036’s tracking of federal enrollment data. But selections are not the same as coverage: the number of Texans who actually paid for and kept their plans fell from 3.42 million in 2025 to 3.28 million this year, a 4% drop and the first decline since 2019, the Texas Tribune reported in July.
The gap opened after Congress let the enhanced premium tax credits — the larger federal subsidies in place from 2021 through 2025 — expire, which KFF says pushed average premium payments up 58% this year and drove about 3 million people off the marketplace nationally.
That exodus is itself a driver of next year’s increases. When healthier people drop coverage, the customers who remain are costlier to insure on average, and insurers price for it. One of the Texas filings quoted in the analysis, from Antidote Health, builds in a 6% adjustment for exactly that: the company expects “the remaining risk pool in 2027 to have higher healthcare needs, on average, as healthier consumers are more likely to lapse coverage.”
Peterson-KFF estimates the subsidy expiration is adding roughly 4 percentage points to 2027 rate requests, on top of a similar effect already baked into this year’s premiums. Only a portion of Texas insurers’ filings are publicly available, the analysis notes, so the state-specific picture will sharpen as the Texas Department of Insurance completes its review.
The biggest single factor, though, is the underlying cost of care. Insurers report that medical costs — hospital stays, physician visits and prescription drugs together — are rising at a median 10% for 2027, above the 8% pace of recent years. The filings cite hospital price increases, labor shortages pushing up provider reimbursement demands, more intensive billing, and the high cost of GLP-1 drugs such as those used for diabetes and weight loss. Some insurers have dropped weight-loss coverage of those drugs to hold premiums down; others say diabetes-related use keeps climbing regardless.
There is a partial cushion. Most marketplace enrollees — 87% nationally in 2026, per KFF — still receive some federal subsidy, and subsidized customers are partly insulated because assistance rises with benchmark premiums. But Texans earning just above four times the federal poverty level, about $62,600 for a single person, now get no help at all and absorb every dollar of these increases. For a state that leads the nation in both marketplace enrollment and the number of uninsured residents, the arithmetic points one direction: unless regulators cut the requests substantially, the bill for staying covered goes up again.
Final 2027 rates will be posted in late summer, and Texans will see them for the first time when open enrollment begins November 1.