ACA premiums jump 15% as new ID checks and broker rules take effect

Open enrollment for Affordable Care Act coverage begins November 1 in most states.

Shoppers facing 2027 coverage will encounter a mix of financial increases and procedural hurdles. Average premiums are projected to rise by 15%, a slowdown from the 26% spike seen in the previous year. This increase follows the expiration of enhanced subsidies at the end of 2025, which led to a decline in overall enrollment. The Trump administration credits its anti-fraud efforts for the drop, noting that 760,000 policies were canceled in August due to suspected improper sign-ups.

The Centers for Medicare and Medicaid Services has introduced stricter identity verification rules for consumers using agents in the federal marketplace. These rules apply to 29 states that use the federal platform. All consumers using an agent must now provide a one-time confirmation code via text, email, or phone call to authorize the agent. Those deemed high-risk must verify their identity through a third party like Experian. CMS defines high-risk applicants as first-time buyers, those changing states, or individuals with monthly premiums of $30 or less.

Joshua Brooker, an insurance agency owner in Pennsylvania, noted that the $30 threshold likely targets low-cost plans where policyholders might not receive bills. He expressed concern that up to one in five consumers will face extra proofing steps. Stacey Pogue, a research fellow at Georgetown University, said the changes target fraud but may create hurdles for people without established credit files or those who have changed names.

A new moratorium will limit the number of available brokers. Agents not registered with the federal marketplace in 2026 cannot assist with 2027 enrollments until February. CMS stated that new agents accounted for a disproportionate number of compliance concerns this year. Jason Fine, a Florida broker, agreed with the concept but worried about the short-term impact on staffing. His agency planned to hire up to 10 agents but found few available who met the registration requirement. He suggested the rule benefits larger call centers that maintain year-round staff.

Agent groups have challenged the moratorium in court. The National Association of Benefits and Insurance Professionals filed a lawsuit on October 15, arguing it unfairly targets 19,000 agents. Health Agents for America filed a separate suit on October 21 seeking a temporary restraining order. Ronnell Nolan, president of the latter group, said new agents are not inherently fraudulent and that agencies have already invested thousands of dollars in training.

Subsidies will remain for many shoppers, though they are less generous than before. The income threshold for subsidies is set at four times the federal poverty rate, which is $63,840 for a single person and $109,280 for a family of three. The One Big Beautiful Bill Act removed subsidy eligibility for many lawfully present immigrants, including those with H-1B visas, refugees, and those with temporary protected status. Green card holders and certain Cuban and Haitian immigrants remain eligible. Louise Norris of HealthInsurance.org advised consumers to compare plans rather than letting policies auto-renew, as out-of-pocket maximums will rise by 13% to $12,000 for individuals in 2027.