What The End of ACA Premium Tax Credits Means for 2027 Open Enrollment
With open enrollment once again on the horizon, Arizonans are looking at another year of increases to health insurance premiums. Affordable Care Act (ACA) Marketplace plans were already more expensive in 2026, after the health care tax credits expired. Republicans in Congress let the ACA premium tax credits expire at the end of 2025.
For Arizonans with marketplace health insurance, higher ACA premiums can result in forgoing insurance altogether, delaying appointments, or making difficult decisions between health insurance costs and other expenses like groceries, rent, and utilities. These trade-offs are not just hypothetical – they are happening in real life. One woman in Pima County said she was eating less due to her rising premium costs, and staying away from the doctor’s office as much as possible.
Read on to learn more about how the absence of ACA premium tax credits is raising costs for Arizona families, and what you need to know ahead of open enrollment on November 1.
Affordable Care Act Premium Tax Credits: A Recap
Since it was opened in 2013, the ACA Marketplace has offered an organized way for individuals and families to buy their own health insurance – particularly for people who cannot get insurance through work or public programs. Last year, 24.3 million people enrolled in Marketplace coverage, including people who are self-employed, shift workers, gig workers, farmers, ranchers, and veterans who rely on the Marketplace for necessary health coverage.
Since 2014, the cost of premiums for ACA plans has been determined by a sliding scale based on the income of the enrollee. Those premium tax credits were enhanced in 2021, lowering rates even more in response to the COVID-19 pandemic and rising costs. In 2025, 379,185 Arizonans received these critical tax credits.
Congressional Republicans allowed those enhanced credits to expire at the end of 2025. Hundreds of thousands of Arizonans were forced to pay significantly higher premiums or drop their health care altogether. In January, Congress had an opportunity to extend the credits for three more years. The bill passed 230-196, but every Republican member of Arizona’s delegation voted against extending the credits. Since then, Arizonans have faced rising premiums and record high deductibles, and the outlook for 2027 is looking even worse.
2026 Saw Rising Premiums and Enrollment Drop Off
This year, premium payments increased by an average of 58% nationally – from $113 to $178 per month. Meanwhile, average ACA Marketplace deductibles soared to a record high of $3,786. This increase reflects the choice many enrollees make to trade higher premiums for higher-deductible plans. For example, although overall marketplace enrollment in Arizona dropped between 2025 and 2026, the number of enrollees on bronze plans actually rose – from 154,730 in 2025 to 200,376 in 2026.
In just the two months after December 2025, 2.2 million fewer people were enrolled in marketplace plans. Between December 2025 and February 2026, marketplace enrollment in Arizona dropped from 336,774 to 255,927 – a 24% decrease. Healthier enrollees were more likely to drop their coverage, creating an enrollment pool that is sicker overall. This creates one reason for rising premium costs – individual market insurers expect the pool to continue to deteriorate in 2027 due to the expiration of premium tax credits, and are looking to raise costs accordingly.
Arizonans Will Face Even Higher Premium Costs in 2027
Based on insurers’ proposed rate changes, premiums are poised to rise again. In August, ACA Marketplace insurers’ requested rate changes for 2027 were made public. Rates are the underlying costs used to calculate premiums for a specific insurance plan. They vary based on factors such as an applicant’s age, ZIP code, smoking status, and family size. Nationally, ACA Marketplace insurers are proposing a median rate increase of 15% in 2027, after already rising an average of 22% this year. Here in Arizona, some proposals go well beyond that. Six major Arizona insurers proposed rate changes of over 24%:
Blue Cross and Blue Shield of Arizona, Inc. - 29.59%
Health Net Community Solutions of Arizona Inc - 27.96%
Health Net of Arizona, Inc. - 24.55%
Imperial Insurance Companies, Inc. - 30.08%
Oscar Health Plan, Inc. - 33.90%
UnitedHealthcare of Arizona, Inc. - 28.63%
Federal and state regulators will review proposed rate changes before open enrollment begins.
These higher premiums will be felt across the state, but will be especially concentrated for small business owners, farmers, and ranchers.
Small Business Owners, Ranchers, and Farmers Feel The Impact
Groups affected by the expiration of premium tax credits include small business owners, military veterans, ranchers, and farmers. Nonelderly veterans, who don’t receive health insurance through the Department of Veterans Affairs (VA), depend upon premium tax credits to be able to afford coverage. Rolling back the enhanced premium tax credit prevents 267,000 of currently eligible veterans from receiving a credit. Meanwhile, nearly a third of farmers, ranchers, and other agricultural workers rely on individual market coverage for their health insurance – and if they get this coverage through the Marketplace, which most of them do, odds are that they received a tax credit in past years to lower their monthly premium cost. They will continue to be forced to make difficult decisions about whether to keep their plans.
Upcoming Open Enrollment Info
Open enrollment for 2027 coverage starts November 1. For a plan with coverage that starts January 1, enroll by December 15. The final deadline to enroll is January 15, for coverage that starts February 1. For more information, visit https://www.healthcare.gov/.