Health Insurance Premium Increase 2027 by State.

The 2026 open enrollment season brought a 21% average ACA premium increase nationwide. 2027 is shaping up to be worse. Insurers are already submitting 2027 rate requests, and the early numbers signal that employers who do not act before open enrollment will face the largest consecutive two-year premium increase since the ACA's first years. Washington state insurers have requested an average 22.4% increase for 2027. Vermont filed 6.5%. Some carriers are requesting up to 30%. This article tracks every 2027 state-by-state rate filing as it is submitted and approved.

Quick answer: what the first 2027 filings show

The first states to release 2027 ACA marketplace rate filings show a wide range, with Washington state at the high end and Vermont at the low end.

Washington state insurers filed a weighted average premium increase of 22.4% for 2027, according to preliminary filings tracked by ACA Signups (June 2026). Thirteen insurers filed rate requests in Washington. Washington's 2026 Silver plan average was already $761 per month, up 40% from 2025. A 22.4% increase on top of that pushes the 2027 Washington benchmark toward $932 per month for a 40-year-old.

Vermont filed its 2027 preliminary rates in May 2026, with insurers requesting an average increase of 6.5%. Vermont is consistently among the highest-premium states in the country. Its 2026 average was $1,224 per month. A 6.5% increase would push Vermont's 2027 benchmark toward $1,303 per month.

Nationally, early filings and insurer commentary indicate that ACA premium rates are rising for 2027, with some carriers requesting increases up to 30% based on medical cost trends and the regulatory environment created by the One Big Beautiful Bill Act (OBBBA), signed July 4, 2025.

Live tracker: 2027 rate filings by state

This table shows 2027 preliminary rate filings where available, with 2026 approved rates as the baseline. States without a 2027 figure have not yet submitted or publicly released rate filings. This page updates as each state reports.

2027 filings are submitted May through August 2026. Final approved rates publish by November 2026. This tracker updates as each state's preliminary filing becomes public.

Why 2027 premiums are rising so steeply

2027 premiums are rising for four compounding reasons, each of which operates independently. Together they are pushing carriers to price more aggressively than at any point in the ACA's history.

The OBBBA Medicaid cuts

The One Big Beautiful Bill Act, signed July 4, 2025, makes the largest changes to Medicaid since the program's founding. Per-capita spending caps and new eligibility verification requirements are expected to push millions of previously Medicaid-enrolled individuals off public coverage (Congressional Budget Office, 2025 preliminary score). Many of those individuals will enter the individual ACA marketplace. Carriers pricing 2027 rates are factoring in a sicker, older risk pool than 2026 as Medicaid enrollment declines.

Enhanced subsidy expiration uncertainty

The enhanced ACA premium tax credits introduced under the American Rescue Plan Act and extended through 2025 reduced net premiums for millions of marketplace enrollees. The OBBBA did not fully extend them. Carriers pricing 2027 are uncertain about how many subsidy-eligible enrollees will remain in the pool versus exit coverage. Fewer subsidized healthy enrollees produces a worse risk pool and higher per-member costs.

Medical cost inflation and GLP-1 pressure

GLP-1 medications for diabetes and obesity management (Ozempic, Wegovy, Mounjaro) have become the single largest drug cost driver for commercial carriers. Average per-member GLP-1 costs have more than doubled since 2023. Combined with rising specialty drug costs, procedure cost inflation, and behavioral health utilization increases, carriers are pricing 2027 medical cost trends at 8% to 12% before administrative loads.

Insurer market exits

Several carriers reduced marketplace footprints after 2026's rate environment proved unprofitable in certain states. Fewer competing carriers in a market historically correlates with higher average approved rates. States where carrier count dropped from five to three between 2025 and 2026 are among those with the highest 2027 preliminary rate requests.

2026 baseline: full 50-state table

The 2026 premiums below are approved Silver plan rates for a 40-year-old, sourced from state insurance commissioner filings and CMS rate review data. These are the baseline every employer should understand before 2027 renewal conversations begin. States with the highest 2026 premiums and the steepest 2026 increases are the ones most likely to see continued pressure in 2027.

Source: ACA marketplace Silver plan rates for a 40-year-old, state insurance commissioner filings and CMS rate review, as reported by Peterson-KFF Health System Tracker.

What a 2027 increase means for employers

For employers offering group health coverage, 2027 ACA marketplace premium increases matter in two ways. First, group plan carriers benchmark their renewal rates against the individual market risk environment. When individual market medical cost trends run at 10% to 12%, group plan renewal increases of 8% to 15% follow. Second, ACA premium increases determine whether employees can afford individual marketplace coverage as an alternative to employer-sponsored plans, which affects workforce retention and benefit value perception.

A Texas employer whose group plan renews in January 2027 should expect to be presented with a renewal increase reflecting the same medical cost inflation that drove Texas's 2026 ACA Silver plan to $826 per month, up 35% from 2025. The Section 125 cafeteria plan→ is the one tool that directly reduces the cost of employer-sponsored coverage without changing the underlying plan design.

The Section 125 FICA recapture math

Under a Section 125 premium-only plan, employee health insurance premium contributions convert from after-tax to pre-tax deductions. The employer recaptures 7.65% of every pre-tax dollar in reduced FICA taxes. For a 50-person employer with each employee contributing $540 per month, the employer FICA recapture is $540 x 12 x 7.65% x 50 = $24,786 per year. That recapture partially or fully offsets the 2027 premium increase cost.

The full mechanics of FICA recapture across different wage levels are detailed in our Section 125 Plan cost guide→. For employers without a §125 plan, this is the first and fastest lever to pull before 2027 renewal letters arrive.

The OBBBA Medicaid eligibility changes are expected to reduce Medicaid enrollment by millions, with a significant portion of those individuals entering the ACA marketplace and driving carriers to price more aggressively for 2027.

States to watch for 2027

The states most likely to see the steepest 2027 premium increases are those that already absorbed the largest 2026 increases AND have structural factors driving continued pressure.

High-risk states for continued increases

These states have limited carrier competition, high medical cost baselines, or large Medicaid populations vulnerable to OBBBA eligibility changes. Washington's early 2027 filing at +22.4% confirms the pattern.

Moderate-risk states

States with 2026 increases in the 20% to 30% range are likely to see 2027 filings in the 10% to 20% range as carriers price above 2025 losses. Nebraska (+29%), Illinois (+30%), Delaware (+31%), Georgia (+32%), and Nevada (+34%) fall in this category.

Lower-risk states

Vermont (+6%), Alaska (-5%), New York (+5%), South Dakota (+6%), and Hawaii (+8%) saw relatively modest 2026 increases. Vermont's 2027 filing at +6.5% continues that pattern. These states tend to have more stable carrier markets and stronger state-level rate review oversight.

Four levers to control 2027 costs

Employers have four levers to control group health costs in a rising premium environment. None of them require dropping coverage or reducing benefits.

Lever 1: Section 125 cafeteria plan

Converting employee premium contributions to pre-tax status does not change the premium. It reduces the employer's FICA tax by 7.65% on every pre-tax dollar. For employers without a Section 125 plan, this is the first and fastest lever. Benecor charges $35 per enrolled employee per month. For most employers with average employee premium contributions above $457 per month, the FICA recapture exceeds the admin fee from the first enrolled employee. The full pricing breakdown is in our Section 125 plan cost guide→.

Lever 2: Plan design review

Moving from a PPO to an HDHP with an HSA→ or a level-funded plan can reduce employer premium cost by 15% to 25% without eliminating coverage. The trade is higher employee cost-sharing. For workforces that are younger and healthier, the trade often works. For older or higher-utilization workforces, it may not.

Lever 3: Supplemental and zero-cost benefits

Zero-cost supplemental benefits (virtual primary care, generic prescription coverage, mental health access) reduce claims utilization on the primary carrier and can lower the next renewal increase by improving the group's claims experience.

Lever 4: Alternative coverage structures

For employers with fewer than 50 employees who are not ACA-mandate-obligated, small business health insurance alternatives→ including healthshare plans→, level-funded coverage, and ICHRA structures→ may deliver equivalent or better benefits at lower per-employee cost than group ACA plans in high-premium states.

2027 rate filing timeline

For employers renewing in Q4 2026 or Q1 2027, the window between now and September 2026 is the critical planning period. Renewal letters will arrive with the new rates, and employers who have already modeled their §125 offset will be positioned to respond immediately.

Next steps for employers

The fastest path is a 15-minute call. We pull two months of your payroll data, model your exact §125 recapture against your projected 2027 renewal, and return a written number, in dollars, that you can take to ownership. There is no obligation, no cost for the analysis, and no payroll system change required to get the projection. Book the call here.

If your group plan renews in Q4 2026 or Q1 2027, now is when the math matters. Do not wait for the renewal letter. Read the complete Section 125 guide→ or review the 2026 baseline→ to understand the starting point.