Full-Price ACA Premiums Rise 13% for 2027, Faster in Reinsurance States

Full-price Silver premiums on Affordable Care Act (ACA) marketplaces rose 13.0% for 2027, from an average of $758 to $856 a month for a 40-year-old. That's $99 more each month, or $1,182 more over the year.

More people pay that full price than a year ago. The expanded premium tax credits that began in 2021 expired at the end of 2025, and 3.1 million people picked a 2026 marketplace plan without a tax credit, up from 1.9 million in 2025, CMS open enrollment data shows.

State prices differ by more than $850 a month: the same coverage averages $1,433 in Vermont and $579 in New Hampshire.

Some of the largest increases came in states with programs built to hold premiums down. Eighteen states run reinsurance programs, which pay part of insurers' highest claims. Those states still pay less on average ($761 a month vs. $888), yet their premiums rose 15.3% for 2027, compared with 12.4% everywhere else.

MoneyGeek priced 2027 Silver plans by hand on the marketplace websites of 20 states and D.C., the second year it has collected these prices directly. Federal plan files don't cover those state-run marketplaces until months after open enrollment. For the 29 states on HealthCare.gov, MoneyGeek used CMS plan and rate files.

For costs at other ages and coverage levels, see MoneyGeek's guide to how much health insurance costs.

Twelve states and D.C. average less than $750 a month for a 40-year-old, and five states top $1,150.

A 40-year-old in Vermont pays about 2.5 times what the same Silver coverage costs in New Hampshire. The difference between the cheapest and most expensive states grows with age, reaching $1,481 a month at 59.

Wyoming, West Virginia and Alaska follow Vermont at the top of the 2027 ranking, and Iowa and Virginia rank just above Maryland and New Hampshire at the bottom. Each row shows a state's 2027 and 2026 premiums, the dollar and percent change, and whether the state runs a reinsurance program.

Washington had the largest increase in the country at 30.1%. The average Silver premium for a 40-year-old went from $732 to $952 a month, adding $2,647 to a year of coverage.

Silver plans sold in both years rose 21.4% on average. Changes in the plan lineup added the rest. Premera added a Silver plan in four of the nine counties MoneyGeek tracked, priced at $1,420 to $1,567 a month for a 40-year-old. Ambetter's Balanced Care 4 Silver plan, which cost $552 to $677 a month in 2026, left all nine counties.

That first-place rank depends on the lineup change. Measured only on plans sold in both years, Washington's 21.4% would fall below Rhode Island's and Delaware's 25.2%.

Rhode Island and Delaware followed at 25.2% each. In Rhode Island, the average went from $577 to $722 a month. Delaware's rose from $759 to $950, adding $2,290 to a year of coverage.

Nine states saw increases above 20%: Washington, Rhode Island, Delaware, Maryland, New Jersey, Oregon, Montana, South Carolina and New Hampshire. Washington and South Carolina are the only two without a reinsurance program.

Maryland and New Hampshire rose 21.4% and 20.2% and are still the two cheapest states in the country, at $580 and $579 a month.

At the other end, two states got cheaper. Arkansas fell 3.1%, from $823 to $798 a month, and Iowa slipped 0.5%, to $587. Vermont rose 0.7%, Connecticut 4.7% and Nebraska 6.0%, the smallest increases among states that didn't fall.

Reinsurance states still have lower prices, but the difference shrank for 2027: full-price premiums in the other states ran 19.7% higher in 2026 and 16.7% higher for 2027. A reinsurance program pays part of the cost of insurers' most expensive claims. That lets insurers charge everyone less. Eighteen states run one under a Section 1332 waiver, the part of the ACA that lets a state change its marketplace rules with federal approval.

In those 18 states, the average full-price Silver premium for a 40-year-old is $761 a month. In the other 32 states and D.C., it's $888.

The increases ran the other way. Premiums rose 15.3% in reinsurance states and 12.4% everywhere else, and the median state change was 15.7% vs. 11.9%. Fourteen of the 18 reinsurance states rose faster than the 13.0% national figure, compared with 15 of the other 33 jurisdictions.

That pattern is new. Using the same method on the 2025 and 2026 CMS plan files, premiums rose 21.5% in reinsurance states for 2026 and 23.5% in the rest, and the median state in each group rose about the same amount. For 2027, reinsurance states rose 2.9 percentage points faster.

Federal money for these programs shrank first. Under Section 1332, CMS pays each state the federal tax-credit savings its program produces.

Those pass-through payments fell in 15 of the 17 states with CMS letters for both 2025 and 2026, and the median drop was 24%. Payments to the 17 states fell 8.7% combined, from $4.09 billion to $3.73 billion. New Jersey and Wisconsin were the only states to receive more.

The size of a state's funding cut doesn't predict its 2027 increase. Delaware's payment fell 46%, the largest cut, and its premiums rose 25.2%. New Jersey's payment rose 21%, and its premiums rose 21.3% anyway. Insurer costs and changes to each program's design also feed into rates, and this analysis doesn't separate those effects.

Two reinsurance states came in well under the national figure. Minnesota rose 7.8%, and Nevada, whose waiver took effect in 2026, rose 9.7%.

Western states had the largest increases for 2027. Premiums there rose 15.4%, and nine of the 13 Western states topped the 13.0% national change. Washington, Oregon and Montana each rose more than 20%.

The Northeast has the highest prices, at $967 a month on average. Its premiums rose 11.6%, and the Midwest's rose 11.4%, the two smallest regional increases.

The 10 states that haven't expanded Medicaid saw faster increases. Premiums there rose 14.2%, compared with 12.5% in the 40 expansion states and D.C. Nine of the 10 topped the national change; Texas, at 11.5%, was the exception.

The type of marketplace made little difference: states that run their own marketplaces averaged $855 a month and rose 13.2%, compared with $858 and 12.8% in HealthCare.gov states.

Seven of the 10 non-expansion states are in the South, and the expansion and regional patterns overlap. These group averages describe where increases landed and can't establish that a policy caused them.

The prices in this study are what a buyer pays with no premium tax credit. With the expanded credits gone, households earning more than 400% of the federal poverty level no longer qualify for one. CMS open enrollment data shows 3.1 million of the 23.1 million people who picked a 2026 marketplace plan, or 13.4%, enrolled without a premium tax credit.

Age raises the bill. ACA rules let insurers charge older adults up to three times what they charge a 21-year-old. In 46 states, a 59-year-old pays 2.04 times what a 40-year-old pays for the same plan.

The average Silver premium for a 59-year-old is $1,662 a month in 2027, or $19,947 for the year. In Wyoming, it's $2,660 a month, or $31,922 a year. A 59-year-old pays more than $20,000 a year for the average Silver plan in 23 states.

Adults 55 to 64 made up 5.2 million of 2026 marketplace plan selections, or 22.4%. Wisconsin had the highest share of any state at 36.9%, and a 59-year-old there pays $20,265 a year for the average Silver plan.

New York and Vermont don't vary premiums by age. A 59-year-old in New York pays the same $1,195 a month as a 40-year-old.

MoneyGeek measured the average monthly premium of every Silver marketplace plan for a 40-year-old nonsmoker in each of the 50 states and D.C. for the 2027 plan year. Premiums are full prices, before premium tax credits.