On July 8, 2026, KFF published its first look at 2027 rate filings from 77 ACA Marketplace insurers across 16 states and the District of Columbia. The median proposed premium increase is 14 percent. Most insurers asked for something between 10 and 20 percent, and 20 of the 77 asked for more than 20 percent. Last year the median request at this stage was 18 percent and the median finalized change ended up at 20 percent, so proposed numbers tend to hold or rise, not fall.
If the 2027 requests are approved, KFF notes that Marketplace premiums will have risen by more than a third between 2025 and 2027. We are not health economists and this is not an article about whether that is fair. It is an article about what happens in your front office when a large share of your individually insured patients are shopping for cheaper plans in November, and what happens in your billing office in January when the new cards arrive.
Key takeaways
- Double-digit premium increases push patients toward cheaper plans with higher deductibles, toward different insurers with different networks, or out of coverage. Each path produces a different denial.
- The active-coverage flag on an eligibility response is not enough in January. You need the deductible and the network, checked the day before the visit.
- Know your Marketplace exposure as a percentage of visits now, so that January staffing is a decision rather than a surprise.
- Front-desk staff can explain your network participation and your financial policy. They should not recommend a plan.
Why premiums are rising, in one paragraph
Insurers cite three drivers. First, the underlying cost of medical care and prescription drugs is up about 10 percent for 2027, against roughly 8 percent in prior years, with hospital prices, physician visits and specialty drugs including GLP-1s leading; one insurer told its regulator that GLP-1 costs had tripled in two years. Second, the enhanced premium tax credits expired at the end of 2025. People above 400 percent of the federal poverty level (about $62,600 for an individual) lost subsidies entirely, out-of-pocket premiums rose an average of 58 percent in 2026, and healthier enrollees left. Insurers say that worsened the risk pool by roughly four percentage points of premium last year and expect about the same again for 2027. Third, federal Marketplace rule changes added costs and paperwork. None of these is going away by January.
What this looks like at the front desk
Higher premiums push patients toward three behaviors, and each one has a billing consequence.
| Patient behavior | What we see in the practice | Billing consequence |
|---|---|---|
| Switching to a cheaper plan with a higher deductible | Same insurer name on the card, different plan, deductible resets in January | More patient responsibility on January and February visits; eligibility checks that say "active" but do not show the new deductible unless you ask for benefit detail |
| Switching insurers to save money | New card, new member ID, sometimes a narrow network that does not include you | Claims sent to the old payer (CO-31); out-of-network denials; referral requirements you did not know about |
| Dropping coverage | Patient arrives believing they are covered because they were in December | Eligibility inactive (CO-27); the visit becomes self-pay after the fact; the balance ages and is rarely collected |
Six things to do before November 1
- Know your Marketplace exposure. Run a payer mix report for the last twelve months and identify the plans that are individual Marketplace products, not employer group plans. The plan name or group number usually tells you; your payer representative can confirm. In many primary care and OB practices this is 8 to 15 percent of visits; in some specialties it is higher.
- Check your network status for 2027 products. Insurers file new narrow-network products every year. Ask each Marketplace insurer for the list of 2027 plans you are in network for and get it in writing. Narrow-network surprises are the most common January denial we see.
- Move eligibility verification to the day before the visit, every visit. Not once per year, not once per quarter. In January the deductible field matters more than the active-coverage flag. The short version is a 270/271 transaction with benefit detail, not a coverage-only check. We covered the mechanics in our medical billing service description.
- Update your financial policy and collect at time of service. Patients with a $7,000 deductible owe the full allowed amount for most office visits in January. A practice that bills after the fact collects a fraction of that. Post the estimated patient responsibility before the visit and take payment or set up a plan at check-in.
- Prepare a plain-language handout. One page: open enrollment starts November 1, 2026, and the closing date depends on your state's Marketplace; check whether your doctors are in the network of any plan you are considering; ask about the deductible, not just the premium. Patients will ask the front desk, and the front desk should have an answer that is not insurance advice.
- Model the revenue effect. Put a number on it and decide what staffing the January eligibility work needs. The next section shows how.
A worked example
Take a five-provider family medicine practice with 22,000 visits a year and an average allowed amount of $120. Twelve percent of visits, about 2,640, are on individual Marketplace plans. Suppose a third of those patients switch plans or drop coverage for 2027, which is in line with what we saw in practices with a heavy Marketplace mix last January.
| Scenario | Visits affected | What goes wrong without day-before verification | Rough exposure |
|---|---|---|---|
| Higher deductible, same insurer (say 15 percent of Marketplace patients) | About 400 visits in Q1 | Patient responsibility billed after the visit; collection rate falls from most of it to perhaps half | About $20,000 in slow or lost patient balances |
| New insurer, possibly new network (say 12 percent) | About 320 visits in Q1 | Claims to the wrong payer, rework of 30 days or more; some out-of-network denials | About $38,000 delayed; a share written off |
| Dropped coverage (say 6 percent) | About 160 visits in Q1 | Denied CO-27, statement to a patient who did not expect a bill | About $19,000 at risk, most of it uncollectible after the fact |
The assumptions are illustrative and yours will differ. The point is the shape: the same practice that runs day-before verification with benefit detail converts most of the first row into point-of-service collections, most of the second into a correct claim on the first submission, and most of the third into a conversation before the visit instead of a collections letter after it. The verification work is roughly forty extra minutes a day for one staff member in January and February. That is the staffing decision.
The self-pay conversion problem
The quiet leak here is the patient who dropped coverage and did not tell you. The claim goes to the payer, denies for no coverage, sits in a work queue for three weeks, and then a statement goes to a patient who did not expect a bill. Some of those balances are collectible; most are not, and the ones that are cost a second and third statement to collect. The day-before eligibility check catches this before the visit, when the conversation is "your coverage shows inactive, here are your options," instead of after, when it is a collections letter.
Have the options ready: your self-pay rate for a standard visit, a payment plan form, and the Marketplace phone number, since a person who loses coverage may qualify for a special enrollment period. Whoever has that conversation at check-in needs a script and a supervisor to escalate to. We cover the scripts in a separate article next month.
Questions we hear
Should we drop Marketplace plans that pay poorly?
That is a contract decision, not a billing one, and the answer depends on your market. What we would say is: do not decide based on premium headlines. Decide based on your own allowed amounts, denial rates and collection rates for each plan, which you can pull from your practice management system this month. A plan with a low fee schedule and a clean first-pass rate can be worth more than a plan with a higher fee schedule and a 15 percent denial rate.
Will the final rates be lower than the proposals?
Sometimes state regulators trim requests, and sometimes insurers revise upward once they see more of the year's claims. Last year the median went from 18 percent proposed to 20 percent final. Plan for the proposals; adjust in the fall when your state publishes approved rates.
What about patients who lose Medicaid?
That is a different and larger wave, tied to the six-month redeterminations and work requirements arriving at the end of this year. We will cover it separately, because the workflow is different: those patients may qualify for Marketplace subsidies, and a front desk that knows to say so keeps them insured and keeps the practice paid.
What to do this month
- Run the payer mix report and tag every individual Marketplace plan. Write the percentage of visits at the top of the page.
- Send each Marketplace insurer a written request for your 2027 network participation by plan.
- Confirm that your clearinghouse or practice management system returns deductible and benefit detail on the 271, not just active or inactive.
- Draft the one-page patient handout and the financial policy update and have both reviewed before October.
- Build the worked example with your own numbers and decide who owns January verification.
