What to know as open enrollment begins for ACA plans: higher costs, fewer options

Tens of thousands of Mississippians covered by Affordable Care Act marketplace health insurance will face higher premiums and fewer options during this year’s open enrollment period, experts say. 

This is the second consecutive year of double-digit premium increases nationally. The average benchmark premium will rise 23% in Mississippi in 2027, according to KFF data. Last year the state saw a 37% increase in the average premium. 

Many marketplace customers are eligible for income-based subsidies that are expected to help shield them from premium increases. In 2027, the income range for a single person to qualify is roughly $16,000 to $64,000 annually. 

But even those that qualify already face significant premium increases after enhanced subsidies that made insurance more affordable for more than 22 million Americans expired in December 2025. A large share of Mississippians switched to plans with higher out-of-pocket-costs last year after those subsidies expired. 

“It’s the same story we had last year,” said Michael Minor, who leads the Hernando-based Get Covered Mississippi, a statewide, faith-based coalition that helps connect Mississippians to health insurance options. “People are already struggling.”

Open enrollment began Sunday and will continue through Jan. 15. 

Nationally, average premiums will increase 13%. Health insurance plans across the board are seeing rates rise due to inflation and increasing healthcare costs, said Matthew McGough, a policy analyst at KFF. 

Marketplace premium costs are also affected by the downstream effects of the expiration of subsidies that made health insurance more affordable for customers, McGough said. Because more enrollees, and especially healthier people, dropped their coverage, the remaining group of people is smaller, sicker and more costly to insure. 

McGough said he expects marketplace enrollment to continue to decline into 2027. 

“To what extent, I think that remains to be seen,” he said. 

Mississippians will also see fewer options when they shop for plans. Two insurers previously offering plans on the state’s marketplace will not offer plans in 2027: Cigna Healthcare and Molina Healthcare. Three plans, UnitedHealthcare, Oscar Health and Ambetter from Magnolia Health, will continue offering coverage. 

The more limited options for coverage comes at the same time as a temporary freeze on new broker registrations as a part of a federal anti-fraud crackdown and decreased funding for navigators who provide assistance to people shopping for and enrolling in health coverage through the marketplace.

“Together, consumers are potentially going to have less choice and a more difficult time finding avenues to sign up,” McGough said.

Some lawfully present immigrants will lose eligibility for federal financial assistance for marketplace plans in 2027, including refugees and asylees without a green card and people on work visas, among others. Others, including lawful permanent residents, or “green card” holders, will still be eligible for subsidies. 

Declining marketplace enrollment in Mississippi

When Congress first authorized expanded subsidies for marketplace plans in 2021 during the COVID-19 pandemic, Mississippi was one of the states that benefitted the most from the increased federal support, in part because state lawmakers, for over a decade, have chosen not to expand Medicaid. 

Marketplace enrollment peaked in 2025 with over 300,000 people enrolled in plans statewide. 

With the enhanced subsidies, marketplace premiums for people renewing their coverage in 2026 more than doubled on average, according to KFF. Mississippi saw one of the steepest declines in coverage. 

Mississippi Insurance Commissioner Mike Chaney said enrollments have since dropped by half. He said as of Oct. 28, enrollments fell to 135,000 people among the three insurers that will continue to offer plans next year. He said the two plans leaving the marketplace next year have few remaining beneficiaries.

Mississippi’s declining marketplace rolls may also have been impacted by federal efforts to eliminate fraud. 

The Trump administration in September cancelled 315,000 “unauthorized” policies covering more than 760,000 people nationwide, claiming fraud and improper enrollment. A small number of people were errantly disenrolled and later reinstated. 

Marketplace insurers reported that over 2,500 members were disenrolled in Mississippi, said Beth Reiss, communications director for the Mississippi Insurance Department.