ACA premiums are going up again. See what it means for you.

Jess Settle, 39, has dreaded thinking about what will happen to her health insurance. Neither of her two jobs offers health care, and she makes too much money for Medicaid. For this past year, like more than 20 million other Americans, she relied on the Affordable Care Act marketplace, paying $400 a month for her plan. But now her insurer is leaving the marketplace, and as of Dec. 31 she will need a new solution that is likely to be more expensive.

She doubts she can pay more.

“I’m kind of at that crossroads right now, and I’ve been putting it off because it’s so mentally taxing to even think about,” said Settle, who lives in Virginia’s rural Rappahannock County.

Premiums on federal and state-run marketplaces will typically jump by around 15 percent next year, according to a Washington Post analysis of finalized and proposed rate increases. It will be the second straight year of double-digit premium increases, as many Americans are already miserable about the rising cost of food, gas, entertainment and other living expenses.

Nearly 3 million people left the marketplace during a year-long period that ended in early 2026, according to federal enrollment data. By June, only about 20.5 million people were enrolled on the marketplace, according to health policy nonprofit KFF. Roughly another 5 million could lose ACA insurance by the end of 2026 amid increasing costs, lingering effects of the loss of subsidies and new restrictions imposed by the Trump administration.

Insurers cited several factors for boosting ACA premiums, including labor shortages and health care costs that have risen amid the growing use of GLP-1 medications.

For gig workers, small business employees and other Americans on the marketplace, the 2027 rate increases follow an even more dramatic cost spike in 2026 after the expiration of pandemic-era subsidies.

Democrats have discussed expanding Medicare and restoring the expired marketplace subsidies — one of the issues triggering last year’s extended government shutdown — if they take back Congress. Those issues are top of mind for voters concerned about health care ahead of the upcoming midterm elections, amid broader anxieties about inflation and affordability.

In a KFF survey earlier this year of 2025 marketplace enrollees, more than half of them said that they would cut back on household spending to afford health care costs. One in 10 respondents said that they were now uninsured.

As they did for this year, insurers in every state are asking for higher premiums in 2027. The vast majority of price hikes across the country fall between 10 and 20 percent. Some of the biggest changes are expected to hit much of Arizona, New Mexico and Montana, where the average increases will be more than 20 percent. The 2027 rates have been finalized in 37 states and Washington, D.C., with a typical rise in premiums of about 16 percent.

While the jump in private health insurance costs is not quite as dramatic, a recent survey of more than 1,800 employers predicted that per-employee health costs will increase by an average of 8.2 percent in 2027.

“The fundamental dynamic of price setting is that anything that makes insurance more expensive or harder to get is going to push out healthier people more than sicker people,” said Jason Levitis, a fellow at the Urban Institute who studies health insurance policy.

“So sick people are going to fight through administrative burdens. They’re going to be willing to pay more to keep on their health insurance because they know they really need it,” he added. “Whereas healthier people are gonna be like, ‘Oh man, you’re making this really hard, you raised my premiums, whatever, I’m just gonna go back to being uninsured this year.’”

As a rule of thumb, Levitis said, if the pool of insured people becomes less healthy, insurers tend to raise rates to offset the increased costs of their care — potentially driving out even more customers with fewer health issues who feel they can go without pricier coverage. Subsidies like the premium tax credit, which can substantially offset costs, help keep a solid number of people in the system, Levitis said.

The full brunt of the spikes for 2027 will be borne by people with incomes more than four times the federal poverty level — such as individuals making over $63,840 per year or four-person households with over $132,000 in annual income. Roughly 2.5 million enrollees across the country did not receive any tax credit for their premiums, based on enrollment data from February.

Heather Pierce, 49, has been laid off three times in two years from various health care start-ups. The marketplace’s offerings are nowhere near reasonable for her family of four in Flagstaff, Arizona, she said, and would cost more than $2,500 a month to cover herself, her two sons and her husband, who runs a small painting company. Instead, she’s choosing to forgo traditional insurance in favor of a flat-fee health care and delivery model called direct primary care.

For a 40-year-old in Arizona on a Blue Cross Blue Shield marketplace plan making $65,000 a year, the 2026 premium increased from the year before by about 48 percent. The company will increase it again by about 25 percent next year. A premium that would have cost $300 per month in 2025 would have been $444 per month this year, and $555 per month next year, according to The Post’s analysis.

Last year, the changes in federal ACA subsidies caused significant price swings for many Americans, said Stacey Pogue, a health care researcher at Georgetown University’s Center on Health Insurance Reforms. There are no big changes in the formula this year for subsidies, but those who are not eligible for them will feel the pain of rate increases, Pogue said.

In addition, a dozen insurance carriers have already announced that they will exit the ACA marketplace in some states next year, further narrowing consumers’ options even as six small carriers plan to start offering plans in a few states. Cigna Group, which insured about 369,000 people on the marketplace across 11 states this year, said in April it would exit the exchange altogether, saying it did not see a clear way to scale that part of the business. Aetna left the marketplace this year, affecting about a million consumers.

Officials in the Trump administration, meanwhile, say their efforts to crack down on fraud account for the decline in marketplace enrollment. The administration said last month that it was removing about 760,000 enrollees for suspected fraud. It’s not clear yet how those removals of people will impact rates for 2027.

In Oklahoma City, 32-year-old Danielle Szabo, a professional violinist, and her husband, who works several jobs, had relied on the marketplace for years. They watched their costs steadily rise, and in 2025, they paid roughly $650 a month to cover themselves plus their toddler — around the edge of what they could spend, Szabo said. Then their insurer told them their plan was going to go up to about $1,400 a month, and they switched to private insurance instead.

They’ll look again at the marketplace for next year, Szabo said, but it’s unlikely they will find anything better than their private option, whose advantages include a low out-of-pocket maximum compared to what they could find on the marketplace.

“It’s just a fricking maze,” she said.