10 states with steep ACA premium increases for 2027

In 10 states, full-price premiums for Affordable Care Act marketplace plans are rising by an average of 21.7% to 27.9% for 2027. That puts them well above the national picture. KFF put the median proposed increase at about 15% in an Aug. 4, 2026 analysis. ACA Signups, which included some finalized rates, calculated a weighted average of roughly 15% as of Sept. 25, 2026.

Those state figures come from healthinsurance.org, where Louise Norris tracks 2027 rate filings and ranks 53 jurisdictions by their weighted average increase in the individual market. This article is a selection of 10 from that ranking, ordered by the source's figure from highest to lowest. Seven of the 10 states have rates the source marks as finalized. Kansas, Alaska and Mississippi had not been marked finalized as of the source's Oct. 19, 2026 update. Their numbers remain insurer proposals that regulators can still revise.

Every figure here describes the full-price premium before subsidies. The enhanced federal premium subsidies expired at the end of 2025. Average net premiums, meaning what enrollees pay after subsidies, rose 58% in 2026, according to healthinsurance.org. That jump happened even though many people moved to lower-cost Bronze plans. Over the same year, the average full-price premium climbed from $619 a month to $741.

The low end of the list looks very different. Vermont's finalized increase is 3%. Iowa follows at 5.7%, New York at 6% and Utah at 6.7%. Those states sit well below the roughly 15% median, while the 10 states in this article sit well above it.

The slides that follow cover each state's figure, its insurers where the source lists them and the factors that shape what enrollees will actually pay. Those include how subsidies are calculated, the income cliff that returned for 2026 and the reasons insurers give for higher costs. Open enrollment for 2027 coverage starts Nov. 1 in most states. That is when current enrollees and new shoppers can see how 2027 ACA premium increases translate into the plans sold where they live.

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Arizona's individual-market ACA premiums will rise by a weighted average of 27.9% for 2027, and those rates are finalized. That is the highest figure in the state-by-state ranking compiled by healthinsurance.org.

The 27.9% describes full-price premiums. That is the sticker cost of a plan before any federal subsidy is applied. The figure applies to coverage that individuals and families buy themselves rather than get through an employer. Because the rates are finalized, the figure is no longer a request that regulators could trim before open enrollment.

Arizona's small-business market is also getting more expensive, but by less. Employers buying small-group coverage face a final increase of 19.7% for 2027, according to an ACA Signups report dated Oct. 22, 2026. The individual market's average increase is 8.2 percentage points higher than the small-group figure.

What an Arizona enrollee actually pays depends largely on premium subsidies. Those subsidies are paid as tax credits. Enrollees can apply the credits in advance to lower their monthly premium. The size of the credit is tied to the benchmark plan, which is the second-lowest-cost Silver plan available where the enrollee lives. It is not tied to the price of the plan a person ends up choosing.

The subsidy covers the gap between the benchmark plan's price and a set share of the household's income. When the benchmark's price climbs, the subsidy climbs with it. For many subsidized enrollees, a larger subsidy may offset some or all of the full-price increase.

Tying the credit to the benchmark has a side effect. A person whose plan rose faster than the local benchmark could still pay more after subsidies. A person whose plan rose more slowly could pay less.

Subsidies have been rising alongside full-price premiums. The average premium subsidy reached $650 a month in 2026, up from $550 in 2025. That is a $100 monthly increase in a single year. Both averages are national figures, not Arizona-specific ones.

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Alabama's individual-market health insurance premiums will rise by an average of 25% for 2027, according to the weighted-average calculation by healthinsurance.org. The rates are finalized, and the figure places Alabama second among the 10 states in this selection.

The 25% figure describes full-price premiums, meaning the amount insurers charge before any federal premium subsidy is applied. It is a weighted average. Insurers with more enrollees count more heavily in the result than smaller ones.

Alabama had 324,504 Marketplace enrollees in early 2026. Most of them buy coverage from a single insurer. Blue Cross and Blue Shield of Alabama reported about 184,000 enrollees in its rate filing, which is more than half of the statewide total. Celtic listed 66,674 enrollees, and Oscar listed 873.

UnitedHealthcare redacted its enrollment from its filing. Healthinsurance.org estimated that the insurer covers about 89,000 people. It arrived at that number by subtracting the other carriers' enrollment from the statewide total. The figure is an estimate, not a filed number.

The four insurers' initial requests varied widely. The Alabama Department of Insurance published the proposed increases on Sept. 3, 2026. Blue Cross and Blue Shield of Alabama asked for 19.9%, and Celtic asked for 11.4%. Oscar sought 33.8%, while UnitedHealthcare sought 27.5%.

That spread amounts to 22.4 percentage points between the lowest and highest requests. A statewide average does not show that range. The change any one enrollee sees depends on which insurer and plan they hold.

The September proposals are not the components of the finalized 25% average. Weighting the requests by the enrollment figures above yields roughly 20.3%. Healthinsurance.org does not explain the gap between the proposals and the finalized average.

The carrier-level percentages were early requests. They are not necessarily the rates that will apply when 2027 coverage begins. The 25% weighted average is the finalized figure for Alabama's individual market as a whole.

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New Mexico's individual-market ACA premiums will rise by a weighted average of 24.4% for 2027, a finalized figure in healthinsurance.org's state-by-state calculation. Insurers had asked for 25.6%, leaving the approved average 1.2 percentage points below the original request.

For individual buyers, that means the figure is no longer a request awaiting review. Rate review is the stage where state regulators can approve a carrier's filing as submitted or cut it back. In New Mexico, the approved number stayed close to what insurers sought.

New York, a separate market, shows how differently the review stage can end. Insurers there requested an average of 20.6%, and regulators approved less than a third of that.

Four insurers reported enrollment in their New Mexico filings. Blue Cross and Blue Shield of New Mexico, listed as BCBSNM, had the largest book with 40,188 enrollees. Presbyterian reported 18,699 and Molina reported 18,174, nearly identical totals. UnitedHealthcare listed 9,219.

Together those filings account for 86,280 people, and BCBSNM covers close to half of them. The 24.4% is weighted by enrollment. That gives the largest carrier's rate the biggest pull on the statewide average. The average on its own does not show how each carrier's rate moved.

The 24.4% applies to full-price premiums, before subsidies. A Sept. 1, 2026, update from New Mexico's Office of the Superintendent of Insurance states that state premium support will continue to help enrollees with costs.

The Santa Fe New Mexican describes BeWell as New Mexico's health insurance marketplace, created under the federal Affordable Care Act. The state's Health Care Affordability Fund is one of the main tools New Mexico uses to lower premium costs for individual plans bought through BeWell.

Small businesses in New Mexico face a separate 20.2% increase for small-group coverage in 2027. That figure is still preliminary. It applies to employer plans rather than the individual market. The small-group figure sits 4.2 percentage points below the individual-market average.

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Kansas individual-market plans face a proposed 24.2% average premium increase for 2027, based on healthinsurance.org's enrollment-weighted calculation. The figure is not yet marked finalized, so it remains an insurer request rather than an approved rate.

Kansas sits fourth among the 53 jurisdictions in the source's ranking. Arizona, Alabama and New Mexico are the only states ahead of it, and Arizona's 27.9% is 3.7 percentage points higher. New Mexico's 24.4% sits 0.2 points above Kansas, and Alaska's proposed 22.9% sits 1.3 points below it. Among the three states in this selection whose 2027 rates are still proposals, Kansas has the highest figure. Alaska and Mississippi are the other two.

A proposed rate can still change. State insurance regulators review filings before rates take effect, and the approved number can differ from the request. Until that review is complete, Kansas shoppers are looking at insurers' asking prices, not settled ones.

Four insurers filed Marketplace plans in Kansas, and enrollment listed in their filings totals 57,430 people. UnitedHealthcare is the largest, with 22,178 enrollees. BCBS of Kansas follows with 19,157. Oscar reports 13,410, and BCBS of Kansas City is the smallest, at 2,685.

The two Blue Cross Blue Shield names belong to separate companies, each with its own filing. BCBS of Kansas covers roughly seven times as many Marketplace enrollees as BCBS of Kansas City. Four carriers give Kansas twice as many Marketplace insurers as Alaska or Montana, which each have two in the source's data.

In a weighted average, larger carriers move the result more than smaller ones. UnitedHealthcare and BCBS of Kansas together account for 41,335 enrollees, about 72% of the filing total. Oscar holds about 23%, and BCBS of Kansas City less than 5%. The source does not list carrier-by-carrier rate requests for Kansas. That means the 24.2% cannot be broken down by insurer.

UnitedHealthcare and Oscar also sell plans in other states with large increases in the source's data. UnitedHealthcare appears in the filings for Alabama, New Mexico, Mississippi and Wisconsin. Oscar appears in Alabama and Mississippi.

The 24.2% applies to full-price premiums, before any subsidies are counted.

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Alaska's individual-market insurers have asked to raise full-price premiums by an average of 22.9% for 2027. The figure is healthinsurance.org's weighted average of the state's rate filings, and the source has not marked it finalized. Because the number is still a request, it describes what insurers want to charge rather than what regulators have approved.

Two insurers appear in the source's Alaska data. Premera listed 18,561 enrollees in its filing. Moda listed 5,106. Together that is 23,667 people, and Premera accounts for roughly 78% of them.

In an enrollment-weighted average, the larger carrier's rate carries more influence. Premera's request therefore shapes the statewide 22.9% far more than Moda's does. The source's data do not break out a separate proposed rate for each Alaska carrier. That leaves the weighted figure as the clearest single measure of what the market has requested.

The same concentration matters for the review still ahead. Any change regulators make to Premera's filing would move the statewide average much more than an equal change to Moda's. A final Alaska figure could therefore differ from 22.9% largely on the outcome of one company's review.

A two-carrier market also narrows comparison shopping. An Alaska enrollee weighing one insurer's renewal price has only one other company in the source's data to check.

The 22.9% describes full-price premiums before any subsidy is applied. Most subsidized enrollees may see larger subsidies offset some or all of the increase.

Two groups get no such offset. Enrollees whose income is too high to qualify for a subsidy pay the full increase. So do people who buy individual coverage directly from an insurer outside the Marketplace. Premium subsidies are not available on those plans.

For those buyers, the arithmetic is direct. If the proposal is approved as filed and a plan rises by the average, a $100 monthly premium would become about $123. Over a year, that adds roughly $275 for every $100 of monthly premium. Individual plans can rise more or less than that. An average blends higher and lower increases into one number.

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Montana's individual-market ACA premiums will rise by a weighted average of 22.6% in 2027, based on healthinsurance.org's state-by-state calculation. The figure is marked finalized. It reflects rates that regulators have already approved.

Only two insurers feed into that average. Blue Cross and Blue Shield of Montana (BCBSMT) reported 36,484 enrollees in its filing. Montana Health CO-OP reported 7,739.

Together, those filings cover 44,223 enrollees. BCBSMT accounts for about 82.5% of them. The average is weighted by enrollment. BCBSMT's rate change therefore carries most of the weight in the 22.6% result.

The 22.6% applies to full-price premiums before subsidies. What a Montana enrollee actually pays depends largely on where household income falls relative to the federal subsidy cutoff.

That cutoff sits at 400% of the federal poverty level. It is a hard line again for 2027. The cliff returned after the enhanced federal subsidies lapsed. A household earning above that level does not qualify for any premium subsidy.

The effect showed up in national enrollment data. During open enrollment for 2026 coverage, 87% of Marketplace enrollees qualified for subsidies, down from 92% for 2025. Healthinsurance.org attributes much of that five-percentage-point drop to the return of the cliff.

The 2027 income thresholds sit slightly above 2026 levels. A single person in the continental U.S., which includes Montana, can earn up to $63,840 and still qualify. That limit was $62,600 in 2026. A household of four can earn up to $132,000, compared with $128,600 in 2026.

Those threshold changes come to $1,240 for a single person and $3,400 for a family of four. That is about 2% and 2.6%, respectively. Both are far smaller than Montana's average premium increase.

Montana buyers with incomes above those lines have no subsidy to absorb the change. They pay the full premium for the plan they choose, including whatever rate increase applies to it. Across the state's two carriers, that increase averages 22.6%.

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Washington state's individual-market premiums will rise by a weighted average of 22.2% for 2027, and that rate is finalized. The Washington State Office of the Insurance Commissioner announced the 22.2% average approved increase for the 2027 Exchange market on Sept. 9, 2026.

The figure in healthinsurance.org's state-by-state list matches the number the regulator published. The commissioner's office announced it as an approval, so the 22.2% reflects the outcome of state rate review. It is not an insurer's opening request that could still be revised.

Washington state ranks seventh among the 10 states in this selection. Its average sits half a percentage point above Wisconsin's 21.7%, the last state in this group. Neighboring Oregon ranks just outside the selection, with a weighted average of 21.6%. That leaves the two Pacific Northwest states 0.6 percentage points apart.

Those gaps are small. Fractions of a percentage point separate Washington state from Oregon and from Wisconsin. At that range, the order of the states says less about pricing than the size of the increase they share.

Insurers filing 2027 rates nationwide point to several cost pressures. Hospital costs are one. Drug costs are another, and insurers name GLP-1 medications among them. Insurers also cite labor costs and utilization, meaning how much care enrollees use. General inflation adds to all of those.

Those explanations come from insurers' rate filings in general. The source does not tie any single driver to Washington state's 22.2% figure. They describe the national backdrop for the state's increase, not a breakdown of it.

The source also gives no carrier breakdown for Washington state. It lists no insurer-level rates or enrollment counts for the state's Exchange. A weighted average gives larger insurers more influence over the statewide figure. Without those figures, there is no way to see which companies pulled the 22.2% up or down. Individual plans may rise more or less than the statewide average. Shoppers will see their own plan's price when they compare 2027 options.

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South Carolina's finalized 2027 individual-market premiums rise by a weighted average of 22.1%, according to healthinsurance.org's state-by-state calculation. That figure measures full-price premiums before any subsidy is applied.

The number carries a caveat. Healthinsurance.org describes it as semi-weighted. Three of the state's six carriers redacted enrollment counts in their rate filings. The calculation therefore could not weight every insurer by its actual membership.

One insurer holds most of the market. Blue Cross and Blue Shield of South Carolina, known as BCBSSC, says it covers about 300,000 people. South Carolina had 387,145 Marketplace enrollees in early 2026. Healthinsurance.org puts BCBSSC's share at roughly three-quarters of that total.

The other disclosed figures are much smaller. Ambetter/Absolute Total Care has 67,070 enrollees, and Instil Health has about 2,500. That concentration means most South Carolina enrollees are in a plan priced by BCBSSC.

The steep increase is specific to the individual market. Small-group plans, which small employers buy for their workers, face a final increase of 8.9% for 2027. That is 13.2 percentage points below the individual-market figure, and less than half of it.

Subsidized enrollees face a different calculation. Their premium tax credits are set so that a household pays a fixed share of its income for the benchmark plan. That benchmark is the second-lowest-cost Silver plan in the area.

That required share depends on income. For 2026 it ranges from 2.1% to 9.96% of household income. For 2027 the range moves to 2.15% to 10.22%. The top of the range rises by 0.26 percentage points.

As a result, a subsidized South Carolina household's benchmark contribution follows its income, not the 22.1% full-price increase. The higher percentages do mean a household at the same income level pays a slightly larger share of that income toward the benchmark in 2027 than in 2026.

South Carolina's rates are final. Shoppers will see these prices during open enrollment for 2027 coverage. They are not proposals that regulators could still revise.

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Insurers in Mississippi have proposed a weighted average increase of 21.8% for 2027 individual-market plans, according to healthinsurance.org. The filing is not yet marked finalized, and only three carriers will keep selling Marketplace plans in the state in 2027.

The 21.8% reflects what insurers asked for, not a rate state regulators have approved. If regulators change the filings before they are finalized, the average could move up or down. Like every figure in this list, it measures full-price premiums before subsidies are applied.

The three carriers staying in the market are Ambetter/Magnolia, Oscar and UnitedHealthcare. Their filings list 103,134 enrollees for Ambetter/Magnolia, 24,093 for Oscar and 17,185 for UnitedHealthcare. Combined, that comes to 144,412 people.

Ambetter/Magnolia is the largest of the three by a wide margin. Its filed enrollment equals roughly 71% of the remaining carriers' combined total and more than four times Oscar's count. Oscar accounts for about 17% of that total, and UnitedHealthcare for about 12%. Oscar's filing lists 6,908 more enrollees than UnitedHealthcare's. In an average weighted by enrollment, Ambetter/Magnolia's rate request carries more weight than the other two filings combined.

Other insurers are leaving Mississippi's Marketplace after 2026. The healthinsurance.org analysis does not name them or say how many people they cover. Marketplace enrollees whose insurer is departing will have to choose among the three carriers that remain.

The Mississippi exits are part of a national pattern. Several hundred thousand people across the U.S. must pick new plans because their carriers are leaving the Marketplace at the end of 2026. Those who select a replacement by Dec. 31 will have coverage that starts Jan. 1.

For those Mississippi enrollees, the decision comes down to what Ambetter/Magnolia, Oscar and UnitedHealthcare will charge for 2027. The source does not break the 21.8% average down by carrier. It does not show which of the three requested the smallest or largest change.