Health insurers across all 50 states and D.C. have filed proposed 2027 rates for the ACA marketplace at a median increase of 15%, according to a Peterson-KFF Health System Tracker analysis updated August 3. Rate filings are not final — most states are still in review, with public comment on many filings running into late August — but the direction is set, and it lands on a population that is disproportionately self-employed.
Roughly 48% of adults under 65 with individual-market coverage are small business owners, self-employed entrepreneurs, or employees of firms with fewer than 25 workers. Small business owners are not incidental to this market. They are close to half of it.
What happened
The Peterson-KFF analysis, first published July 8 and updated August 3, reviewed publicly available filings from 276 insurers. The median proposed increase for 2027 is 15%.
Drilling into detailed rate justifications from 77 insurers across 16 states and D.C., the drivers break out roughly as follows:
- Medical trend — the underlying cost of care — is the largest single component, at a median of 10%.
- Expiration of enhanced premium tax credits adds approximately 4 percentage points on its own, by pushing healthier enrollees out of the risk pool.
- Provider consolidation, labor shortages, and claims severity (providers coding for higher-acuity services) compound the medical trend.
- GLP-1 medications tripled costs in some markets; several insurers responded by dropping weight-loss coverage.
The compounding matters more than any single year. The analysis cites a 40-year-old in Indianapolis going from $316 a month with enhanced credits in 2025 to a projected $546 in 2027 — a $158, or 41%, increase over two years.
That is on top of what already happened this year. After the enhanced subsidies lapsed, average premium payments after subsidies rose 58% in 2026, and healthier enrollees left the market — which is precisely why insurers are pricing 2027 for a sicker, more expensive pool.
Why it matters
There are two separate stories inside this that get conflated, and small business owners sit in both.
The first is the employer story: whether you offer coverage to your team. The second is the owner story: where you and your spouse get your own coverage. For a large share of the businesses CentsIQ works with, the second one is the individual marketplace — and it is the one repricing by 15% at the median.
“About half of adults with ACA Marketplace coverage are small business owners, employees, or self-employed.” — KFF
There is also a subsidy-cliff mechanic that catches profitable owners specifically. With the enhanced credits gone, households above 400% of the federal poverty line lose premium tax credit eligibility entirely — not gradually. A good year, a one-time gain, or a distribution timed into the wrong tax year can move a household across that line and take the entire subsidy with it.
What this means for small business owners
Budget the increase now, not at open enrollment. Median 15% is the filing, not the final approved number, and your state and plan may land above or below it. But putting a 15% placeholder into your 2027 personal draw and household budget in August is cheaper than discovering it in November.
If you’re near 400% FPL, model your income before year-end — not after. Because the cliff is now a cliff again rather than a phase-out, the last quarter of the year is where the decision actually gets made: timing a distribution, a bonus, a retirement contribution, or an equipment purchase can determine whether you keep subsidy eligibility at all. This is a bookkeeping and tax-planning question with a five-figure answer, and it has to be run before December 31.
Reconcile what you’re actually paying. Owner health premiums move between the business return, the self-employed health insurance deduction, and personal itemized deductions depending on entity type and how the policy is held. If premiums jump 15%, the deduction treatment is worth confirming rather than assuming — the wrong classification gets more expensive as the number gets bigger.
If you offer group coverage, get your 2027 small-group renewal quote early. Small-group and individual markets are priced separately, but the same medical trend drives both. Ask your broker for the renewal before you finalize headcount plans.
Watch the comment windows. Filings are still in state review, with comment periods on many closing in late August and final approved rates arriving in the fall. The number you plan against in August is a proposal; confirm it before you commit contractually to anything that depends on it.
The bottom line
A 15% median filing increase, stacked on a year in which post-subsidy payments already rose 58%, makes health coverage one of the fastest-growing line items a self-employed owner will carry into 2027 — and roughly 4 points of that increase traces directly to a policy change rather than to medical costs. Final rates arrive in the fall. The planning that actually changes your number, particularly around the 400% FPL cliff, has to happen before the year closes.
