What's Happening With Health Insurance Right Now — and What It Means for Southwest Florida

Health insurance got more expensive in 2026, and it's rising again for 2027. The main reason: the enhanced premium tax credits that lowered marketplace premiums during the pandemic expired at the start of 2026, and Congress has not passed a replacement. On top of that, insurers have filed further rate increases for 2027. If your coverage costs more than it did two years ago, you're not imagining it — and understanding why helps you respond intelligently instead of just absorbing the hit.

Here's a plain-language breakdown of what changed and what you can actually do about it.

The enhanced subsidies expired — and the "cliff" came back

From 2021 through 2025, temporary enhanced subsidies made ACA marketplace coverage dramatically cheaper. They capped what enrollees paid as a share of income and removed the old income ceiling on eligibility. Those enhancements ended on January 1, 2026.

The original ACA subsidies still exist and are based on your income and local plan costs — many people still qualify for meaningful help. But two things changed for the worse:

• KFF reports that average monthly premium payments across all Marketplace consumers rose 58% in 2026, from $113 to $178, after the enhanced credits expired; deductibles rose too.
• The 400%-of-poverty subsidy cliff returned. Under the enhanced rules, help phased out gradually. Now, earn one dollar over the threshold and you lose all premium assistance. For some older enrollees, losing the credit can substantially increase annual premiums; the amount depends on age, income, household size, location, and plan.

As of this writing, the situation is politically unsettled: the House passed a multi-year extension of the enhanced credits in early 2026, the Senate has not passed the extension, and it has not become law, so the original rules remain in place. This could change — check HealthCare.gov or ask a licensed agent for the current status before you make decisions.

2027 premiums are rising on top of that

Separate from the subsidy question, insurers set new rates every year. Nationally, carriers proposed a median premium increase of around 15% for 2027, following an 18% median proposed increase in 2026 (20% median after finalization). In Florida, proposed increases run an especially wide range — from under 4% at one carrier to nearly 40% at another — while the state reviews and finalizes rates this fall. We break down the local numbers in our Southwest Florida cost-of-care report [blocked].

The underlying driver is medical cost itself: the price of hospital care, physician visits, and prescription drugs (including high-cost specialty medications) has been climbing faster than in recent years. Combine that with the subsidy expiration, and you get the squeeze so many Southwest Florida households and business owners are feeling at once.

What this means if you buy your own coverage

If you're on an individual plan, do not auto-renew for 2027. Reshop during open enrollment, estimate your income carefully (the cliff makes accuracy critical), and compare total cost, not just premium. Our individual and family health insurance [blocked] page walks through how we help people navigate this, and our open enrollment tips [blocked] cover the step-by-step.

What this means if you're a business owner

Rising individual-market costs change the math for employers too. When employees can't find affordable coverage on their own, group benefits become a bigger factor in hiring and retention — but a traditional fully-insured group plan isn't the only answer, and often isn't the cheapest.

Three strategies are worth understanding right now:

• Alternative funding (level-funded and self-funded plans). Instead of paying a fixed premium into a carrier's risk pool, you pay based on your own group's actual claims and can get money back in a good year. For a younger, healthier workforce — common in trades and construction — this frequently cuts costs 20–40%. See our group health insurance [blocked] page.
• ICHRA (Individual Coverage HRA). A newer model that lets you give employees tax-free dollars to buy their own individual plans, with predictable cost to you. We explain it in this guide [blocked].
• Strategic plan design. Tools like direct primary care, pharmacy optimization, and healthcare advocacy attack the claims that actually drive your cost — see how we approach it on our process page [blocked].

The bottom line

Costs are up because of a policy change plus normal rate increases — but you have more levers than the marketplace makes obvious. Whether you buy your own coverage or offer it to a team, the worst move is to renew the same plan without looking. Reviewing your options for 2027 is the single highest-return hour you can spend on this.

Frequently Asked Questions

Did ACA subsidies go away completely? No. The enhanced subsidies expired at the end of 2025, but the original income-based premium tax credits still exist. Many people still qualify — eligibility now phases out at 400% of the federal poverty level.

How much are premiums going up for 2027? Nationally, insurers proposed a median increase of about 15% for 2027. KFF reports that average monthly Marketplace premium payments across all consumers rose 58% in 2026, from $113 to $178, after the enhanced credits expired. Florida's proposed increases vary widely by carrier and aren't final yet.

I own a business — how do I protect against rising costs? Alternative funding models, ICHRA, and strategic plan design all help control cost in ways a standard fully-insured plan can't. A benefits consultant can model which fits your workforce.

Roger Aboytes is the founder of Vantage Pointe Consulting, an independent benefits firm helping Southwest Florida businesses and families control healthcare costs. Call (239) 273-9173 for a no-cost review.