Plans on the Affordable Care Act's exchanges are set for further premium increases next year, a new report shows.
Analysts at KFF dug into preliminary rate filings from payers for the 2027 plan year and found a median proposed premium increase of 14%. The report is based on filings from 16 states and the District of Columbia, representing 77 insurers.
Should these proposals carry forward, that would mean that premiums on the exchanges have grown by more than a third over three years, from 2025 to 2027. Most plans are requesting increases of between 10% and 20% for the coming year, though 20 payers have requested an increase of more than 20%.
The largest group of payers, 35, is requesting an increase of between 10% and 15%, per the analysis.
Plans have until July 15 to submit their premium proposals for the 2027 plan year, and preliminary filings offer a look at the trends they're seeing, according to the KFF analysts.
The filings cite several reasons as to why premiums continue to escalate, with rising healthcare costs the central concern highlighted by payers. The KFF researchers note that the median increase in the underlying costs for medical care and pharmaceuticals was 10%, higher than the average trend in the past several years.
Beyond healthcare costs specifically, a number of payers also noted that broader economic inflation is a contributing factor in their filings. For example, Anthem wrote in its Indiana documentation that it did not account for tariffs in the rate proposal but did set rates that incorporate "broader economic factors that may influence medical unit costs and pharmacy pricing, including potential impacts to supply chain and input costs."
"These considerations are incorporated into our overall assumptions, including a modest incremental increase to trend above typical contracting adjustments to account for evolving economic conditions," Anthem said, according to the KFF report.
Multiple payers also named increasing claims intensity as playing a role in driving up premiums. There is a consistent trend of providers coding for higher-acuity services that carry higher reimbursement rates, which inevitably trickles down to premiums, the researchers said.
For instance, Blue Cross Blue Shield of Massachusetts notes in its filing for the Blue HMO plan that it has "seen use and severity trend accelerate through the end of 2025." The insurer said its own analyses indicate that this shift in coding intensity drives higher revenue for providers but does not necessarily lead to better care.
"This is not an anomaly, but rather reflects observable, sustained increases in underlying medical utilization and severity identified by our Trend Analytics Team," per BCBSMA. "We are experiencing persistent utilization pressures across multiple service categories, most notably in outpatient surgeries (including digestive and cardiovascular surgeries), rising behavioral health visit volumes, and increased medical pharmacy use."
Other pressures cited include labor shortages, continued demand for GLP-1s and key policy changes implemented under the One Big Beautiful Bill Act. Regulatory changes rolled out by the Centers for Medicare & Medicaid Services over the past two years, as well as the expiry of the enhanced premium tax credits on Jan. 1, are also playing a role, insurers said.
UnitedHealthcare of New York also said it would incorporate the effects of the No Surprises Act's independent dispute resolution process into its calculations, as the IDR process is a factor in the overall rise in medical costs. Payers have argued that providers are flooding IDR to secure higher payouts.
"A rate impact of 0.8% is added for costs associated with the Independent Dispute Resolution process, including both the federal program and additional New York-specific requirements," UHC of New York wrote in the filing.