ACA Open Enrollment 2027: Premium Hikes, New ID Rules, and What Shoppers Must Know

Consumers shopping for Affordable Care Act health insurance this fall face a dramatically different landscape than in previous years. Significant premium increases, enhanced identity verification requirements, and the end of pandemic-era subsidies will reshape the marketplace when open enrollment kicks off across most states on November 1.

Furthermore, millions of Americans have already dropped or lost coverage in early 2026 following the expiration of enhanced subsidies at the end of 2025. Policy experts attribute the enrollment decline directly to this loss of financial assistance. However, the Trump administration views the falling numbers differently, crediting various fraud-reduction efforts including the August cancellation of 760,000 policies suspected to involve improper sign-ups. Only a small number of those enrollees have since regained coverage.

Premium Increases Hit Two-Year High

Across 276 insurers participating in ACA Marketplaces from all 50 states and the District of Columbia, the median proposed premium increase stands at 15% for 2027. This marks the second consecutive year of double-digit premium hikes, following last year’s median finalized rate change of 20%.

Consequently, typical premiums for insurers participating in ACA Marketplaces will have jumped by more than one-third over a two-year period if these proposed rates hold. While the 2027 increase is lower than 2026’s spike, it represents the second-highest requested rate change since 2018. For several years prior, premium growth had remained relatively flat in this market.

Among the hundreds of participating insurers, premium changes range from -1% to 54%. Nevertheless, most insurers-approximately 63%-proposed premium changes falling between 10% and 25%. Only one insurer proposed decreasing premiums. At the other end of the spectrum, some insurers are requesting increases exceeding 50%.

New Identity Verification Rules Slow Enrollment Process

One of the biggest changes this enrollment period involves increased scrutiny of both consumers and agents through requirements aimed at thwarting fraud or improper enrollments. For consumers, these measures will likely slow the enrollment process. The new rules, outlined in a Centers for Medicare & Medicaid Services FAQ, affect only consumers using agents or brokers to help them enroll through the federal marketplace, which serves 29 states.

In contrast, these requirements do not apply to state-based exchanges, which maintain their own rules and have in most cases been more successful at preventing fraudulent sign-ups. State-based exchanges continue to operate under their existing protocols.

All consumers using an agent in the federal marketplace will need to obtain a one-time confirmation code or link to authorize a specific agent to enroll them or make changes on their behalf. The confirmation will be sent to consumers by text message, email, or an automated phone call from one of the private enrollment platforms used by their agent. As a result, returning consumers who have incorrect or outdated contact information will first need to call the federal marketplace themselves or submit an application online to update it.

High-Risk Applicants Face Additional Verification

Additionally, consumers and policyholders deemed “high-risk” must verify their own identity before authorizing an agent. CMS defines as high-risk several categories of applicants: first-time applicants, those with existing coverage whose applications involve a change of state, as well as consumers working with a new or different agent or with a monthly premium payment of $30 or less.

These verification requirements represent a significant departure from previous enrollment periods. Moreover, they signal the administration’s commitment to reducing what officials characterize as widespread enrollment fraud. The measures add complexity to the enrollment process, particularly for vulnerable populations who may lack consistent access to email or mobile phones.

State-by-State Enrollment Timeline Variations

While open enrollment starts November 1 in most states, Idaho, Connecticut, and Massachusetts start earlier. Furthermore, some states are already allowing “window shopping” to check premium rates before the official enrollment period begins. Shoppers need to plan accordingly and verify their state’s specific timeline.

A continued decline in overall enrollment is expected, mainly because of the expiration of enhanced subsidies at the end of 2025. These subsidies, which were significantly expanded during the pandemic, made coverage more affordable for millions of middle-income Americans. Without them, many families face premium increases that make ACA coverage unaffordable.

Immigrant Subsidy Eligibility Changes

In addition to premium increases and verification requirements, shoppers will encounter new limits on which immigrants can get subsidies. These restrictions further narrow eligibility for financial assistance in purchasing marketplace coverage. The changes affect certain immigrant categories that previously qualified for premium tax credits.

Consequently, families must carefully review their eligibility status during the enrollment period. Assuming previous eligibility continues could result in unexpected premium bills or loss of coverage for those who no longer qualify for assistance.

Medicare Open Enrollment Runs Concurrently

Separately, Medicare open enrollment also begins this fall, adding to the complexity for seniors navigating healthcare choices. The Medicare enrollment period, which ends December 7, offers beneficiaries the opportunity to choose between traditional Medicare and privately run Medicare Advantage plans in their area, as well as prescription drug plans.

Open enrollment comes as inflation adds pressure on seniors whose healthcare costs have risen and as midterm elections approach. Voters have consistently identified cost-of-living as a major concern. The Social Security Administration announced that the annual cost-of-living adjustment for older adults and people with disabilities will increase by 3.6% beginning in 2027, translating to $75 extra per month for nearly 72 million people who receive monthly Social Security benefits.

What Shoppers Should Do Now

Given the complexity of this enrollment period, consumers should take several proactive steps. First, verify and update contact information with the marketplace to avoid delays in receiving authorization codes. Second, review current subsidy eligibility carefully, as many families will no longer qualify under the new rules. Third, compare plans early, as premium increases vary widely by insurer and state.

Finally, shoppers working with agents or brokers should expect additional verification steps and allow extra time to complete enrollment. The new security measures, while designed to prevent fraud, will inevitably add complexity to the process. Planning ahead and gathering necessary documentation will help ensure coverage begins on schedule January 1, 2027.