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North America
Major insurers participating in the Affordable Care Act (ACA) marketplace are seeking another round of double-digit premium increases for 2027, citing rising healthcare costs, higher spending on prescription drugs and hospital care, and declining enrollment following reductions in federal subsidies. According to an analysis by KFF, the median requested premium increase across 77 publicly available filings is 14%, following a median 20% increase for 2026. Some insurers have requested especially large increases. Centene is seeking a 28% rate hike in Washington state after raising premiums 35% in 2026, while Blue Cross & Blue Shield of Illinois has requested a 15% increase following a 28% increase this year. Elevance Health has also requested double-digit increases in several states, including Indiana, Connecticut, Kentucky, and Maine. Insurers say reduced federal subsidies have led millions of healthier consumers to leave the ACA marketplace, leaving a smaller, less healthy, and more expensive risk pool. ACA enrollment fell from 22.1m to 19.2m between February 2025 and February 2026, and actuaries expect further declines.
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