Millions face higher premiums, reduced subsidies and fewer choices for 2027 coverage
Open enrollment for health insurance under the Affordable Care Act is underway, but millions of Americans seeking coverage in 2027 face higher premiums, reduced federal financial assistance and fewer insurance options.
The enrollment period began November 1 and continues through January 15, 2027, allowing individuals and families to purchase, renew or change coverage through the federal Health Insurance Marketplace.
For Tennesseans without employer-sponsored insurance, including self-employed workers, small business owners and families who do not qualify for TennCare, the enrollment period offers an opportunity to secure coverage amid rising healthcare costs.
According to KFF, a national health policy research organization, average premiums for benchmark Silver plans are increasing approximately 13% nationwide for 2027, following a 26% increase in 2026.
In Tennessee, approved rate increases average approximately 16.4% before subsidies, according to <Healthinsurance.org>. Actual increases vary by insurer, plan and location.
The rising costs come as enhanced federal premium tax credits, introduced during the COVID-19 pandemic, have expired. Those subsidies helped millions of Americans reduce their monthly insurance payments.
Although traditional Affordable Care Act subsidies remain available, their reduced generosity means many households will pay considerably more for coverage.
Those earning above 400% of the federal poverty level are particularly affected because they generally no longer qualify for premium tax credits. For 2027, that threshold is $63,840 for an individual and $132,000 for a family of four.
The changes could force difficult decisions for families already struggling with rising living expenses. Some may choose cheaper plans with higher deductibles, while others may drop coverage altogether.
“They may or may not be able to afford to continue to keep their coverage into next year,” said Cynthia Cox, vice president/director of the Affordable Care Act Program at KFF, in an interview with the Associated Press.
Cox noted that many consumers have already switched to Bronze plans, which typically offer lower monthly premiums but require patients to pay more of their medical expenses.
The impact is especially concerning for Black Americans and other underserved populations, who continue to experience disparities in healthcare access and outcomes.
National enrollment figures already reflect mounting financial pressure. KFF reports that Marketplace plan selections declined by approximately 1.2 million between 2025 and 2026. By February 2026, active enrollment had fallen to 19.2 million, down 12% from the previous year.
Consumers may also face fewer insurance choices. Five insurers are expected to participate in Tennessee’s Marketplace for 2027, down from six in 2026. Cigna is leaving the state’s individual insurance market, requiring affected customers to select new coverage.
Despite these challenges, federal officials emphasize that affordable options remain available. The Centers for Medicare & Medicaid Services reports that more than 75% of HealthCare.gov shoppers will have access to plans costing $50 or less monthly after applicable financial assistance.
However, consumers should consider more than monthly premiums when selecting coverage. Deductibles, copayments, prescription benefits, out-of-pocket limits and whether preferred doctors participate in a plan’s network can significantly affect overall healthcare expenses.
December 15 is the critical deadline for coverage beginning January 1, 2027. Those enrolling between December 16 and January 15 generally will not have coverage begin until February 1, provided they pay their first premium.
Current Marketplace customers should review their coverage rather than automatically renewing. Changes in premiums, financial assistance and provider networks could make another plan more affordable.
Consumers should also accurately estimate their 2027 household income when applying for premium tax credits. Federal changes have eliminated previous limits on repayment of excess credits, potentially leaving some households with larger tax bills if their income exceeds projections.
Additional restrictions will affect certain lawfully present immigrants who previously qualified for subsidized Marketplace coverage.
After January 15, enrollment generally requires a qualifying life event, such as losing other insurance, getting married or having a child. Medicaid and Children’s Health Insurance Program applications remain available year-round for eligible individuals.
Tennesseans can compare plans, check eligibility for financial assistance and enroll at HealthCare.gov.
With insurance costs continuing to climb, carefully reviewing available plans and meeting enrollment deadlines could make a significant difference in families’ healthcare expenses and access to medical services in 2027.
