Marketplace Insurers Propose Double-Digit 2027 Premium Increases in the State With the Most Enrollees

Health insurers selling plans on the Affordable Care Act marketplace have proposed double-digit premium increases for 2027, and preliminary filings put Florida's average proposed increase at roughly 15.9 percent. Nationally, the median proposed increase is around 14 percent, according to analysis of preliminary rate filings. It would be the second consecutive year of double-digit increases after a steep climb for 2026 plans.

No state has more at stake. Florida has the largest ACA marketplace enrollment in the country, with millions of residents obtaining coverage through healthcare.gov rather than through an employer or a public program. The state did not expand Medicaid, which means marketplace coverage carries a share of the population that in other states would qualify for Medicaid instead.

Proposed rates are not final rates. State regulators review filings, and final approved increases frequently come in below what carriers initially request. But the direction is established, and the underlying cost pressures driving the filings are not in dispute.

What changed for Florida enrollees

The enhanced premium tax credits that Congress enacted in 2021 and extended through 2025 expired at the end of that year. Those subsidies had increased the amount of financial assistance available at every income level and had eliminated the so-called subsidy cliff, the income threshold above which assistance disappears entirely.

With their expiration, the cliff returned. For 2027, subsidies will not be available to households with income above 400 percent of the federal poverty level, though the dollar threshold rises with the poverty guidelines. A single person in the continental United States will qualify with income up to $63,840, compared with $62,600 for 2026.

The households affected most severely are those just above that line. A person earning slightly more than the threshold pays the full unsubsidized premium, which for older enrollees in Florida can exceed a thousand dollars a month.

Enrollment has already fallen

Florida marketplace enrollment declined after the enhanced subsidies expired, a pattern documented in reporting on the state's 2026 open enrollment results. That decline was concentrated among people who found unsubsidized or reduced-subsidy premiums unaffordable.

The dynamic that follows is well understood by actuaries. When premiums rise, the healthiest enrollees are the most likely to drop coverage, since they perceive the least value in it. That leaves a risk pool weighted toward people with higher medical costs, which pushes premiums up further.

That feedback loop is part of what carriers cite in rate filings, alongside underlying medical cost trend, prescription drug costs and utilization patterns that have not returned to pre-pandemic norms.

Why Florida is different

Florida's marketplace is the largest in the country for reasons specific to the state's economy and policy choices. A substantial share of Florida workers are employed by small businesses, in tourism and hospitality, in construction and in the gig economy, sectors less likely to offer employer-sponsored coverage.

The state also has a large population of early retirees, people between 55 and 65 who have left the workforce but are not yet eligible for Medicare. That group is a natural marketplace constituency and also the one facing the highest premiums, since ACA rating rules allow older enrollees to be charged up to three times what younger ones pay.

Florida's decision not to expand Medicaid under the ACA means adults with incomes below the poverty line who do not qualify under the state's existing Medicaid categories fall into a coverage gap, eligible for neither Medicaid nor marketplace subsidies.

What the increases mean in dollars

A 15.9 percent average increase does not apply uniformly. Rate changes vary by carrier, by plan, by rating area and by enrollee age, and Florida has multiple rating areas with different competitive conditions.

For a subsidized enrollee, the practical effect is buffered. Subsidies are calculated against a benchmark plan and cap the enrollee's contribution at a percentage of income, which means when premiums rise, subsidies rise with them for those who qualify.

For an unsubsidized enrollee, the increase lands in full. That is the population that has grown since the enhanced credits expired, and it is where the affordability problem concentrates.

The open enrollment calendar

Open enrollment for 2027 coverage is expected to run from November 1, 2026 through January 15, 2027, following the standard federal marketplace schedule. There has been some uncertainty about the end date, with litigation over a proposed mid-December deadline still working through the courts after a federal appeal in July 2026.

The practical guidance for consumers has not changed. Enrolling by December 15 secures coverage effective January 1. Enrolling after that date generally produces a February 1 effective date, which means a gap.

Auto-renewal into the same plan is the default for existing enrollees who take no action, which is convenient but frequently costly. Benchmark plans change year to year, and an enrollee auto-renewed into a plan that is no longer the benchmark can see subsidies fall even if the plan's premium is unchanged.

What happens to people who drop coverage

Florida's uninsured rate has historically run above the national average, and the marketplace was the mechanism that brought it down. Increases in the uninsured population have downstream effects that reach beyond the individuals involved.

Hospitals absorb uncompensated care costs when uninsured patients receive emergency treatment. Those costs are shifted into the rates hospitals negotiate with commercial insurers, which flows into employer-sponsored premiums.

Florida's hospital systems, including AdventHealth, BayCare, HCA Florida, Orlando Health, Tampa General, Jackson Health and Memorial Healthcare, all carry that exposure, and safety net institutions in urban counties carry the most.

Employers are affected too

Employer-sponsored coverage follows the same underlying medical cost trend that drives marketplace rates. Small businesses in Florida, which make up a large share of the state's employers, face renewal increases in the same range.

For a small employer already dealing with a slowing labor market, where Florida added roughly 4,500 jobs statewide in July, health benefit cost increases compound the pressure on payroll budgets.

Some small employers respond by shifting more cost to employees through higher deductibles and premium contributions, which changes the calculation for workers weighing employer coverage against a marketplace plan.

The prescription drug component

Carriers cite prescription drug costs prominently in rate filings, and the most-cited category in recent years has been GLP-1 medications used for diabetes and weight management. Utilization of those drugs has grown rapidly and their costs are high.

Plan responses have included coverage restrictions, prior authorization requirements and formulary tiering, all of which shift cost or access rather than reducing underlying prices.

Specialty drugs more broadly, including oncology and biologic therapies, account for a disproportionate share of total drug spending relative to the number of prescriptions written.

What Florida's delegation can do

Extending enhanced premium tax credits requires federal legislation, and it has been the subject of repeated congressional debate. Florida's delegation has more constituents affected by that question than any other state's.

The state's two senators, Ashley Moody and Rick Scott, and its 28 House members represent districts where marketplace enrollment runs into the tens of thousands. Miami-Dade County in particular has among the highest marketplace enrollment of any county in the nation.

Health coverage is likely to feature in the November elections, both in the governor's race between Byron Donalds and David Jolly and in the Senate special election between Moody and state Rep. Angie Nixon.

What consumers should do now

The single most useful action for current enrollees is to shop rather than auto-renew when open enrollment opens November 1. Plan availability, networks and benchmark status all shift annually, and the plan that was optimal in 2026 frequently is not in 2027.

Income estimates matter. Subsidies are calculated on projected income, reconciled at tax filing, and an inaccurate estimate produces either a repayment obligation or forgone assistance.

Navigator organizations and certified application counselors provide free enrollment assistance in Florida, and their availability depends on federal funding that has fluctuated between administrations.

How rate review works in Florida

Preliminary rate filings are the opening position, not the final number. Insurers submit proposed rates with actuarial justification, and regulators examine the assumptions behind them: projected medical cost trend, expected enrollment mix, prior year experience and administrative expense loads. Filings that cannot support their assumptions get reduced.

The federal review standard requires that rates be neither excessive, inadequate nor unfairly discriminatory, and it caps the share of premium that can go to administration and profit through medical loss ratio requirements. Insurers that spend less than the required share on medical care must issue rebates to enrollees.

Final approved rates are published before open enrollment so that consumers can compare plans with actual numbers. The gap between preliminary and final figures varies by year and by state, which is why a 15.9 percent average proposal is a signal about direction rather than a precise forecast of what any household will pay.

The Medicaid gap underneath everything

Florida's marketplace carries a heavier load than most states' because the state did not expand Medicaid under the Affordable Care Act. The law was written assuming that adults below the poverty line would receive Medicaid, with marketplace subsidies beginning above that threshold.

In states that did not expand, adults with incomes below the federal poverty level who do not fit an existing Medicaid eligibility category qualify for neither program. That population, sometimes numbering in the hundreds of thousands in Florida, has no subsidized coverage pathway at all.

The practical effect is that Florida's marketplace enrollment skews toward households just above the poverty line who receive the largest available subsidies, alongside self-employed and early-retiree households at higher incomes who now face the restored subsidy cliff. Both ends of that distribution are sensitive to the rate changes proposed for 2027.

What's next

Final approved rates will be published ahead of open enrollment, and they will differ from the preliminary filings. State insurance regulators review filings for actuarial justification, and requested increases are sometimes reduced.

Congressional action on premium tax credits, if it happens, would change the calculation substantially. Absent that, the 2027 plan year will be the second consecutive one in which Florida enrollees face both higher gross premiums and less generous subsidies than they had through 2025.

For Florida households, the practical consequence is another line item rising faster than wages, alongside housing at a $425,000 statewide single-family median, grocery costs among the highest in the country, and property insurance that remains expensive even after recent improvement.