Open enrollment for ACA-compliant coverage starts on Saturday in most states — the second shopping season since the enhanced premium subsidies expired at the end of 2025, and the numbers from the first post-cliff year are now in. For American readers who make up half this site’s audience, they are worth reading before the plan emails start arriving, because the individual market and the videos in our library are connected by the same thread: what care costs when the system’s padding is gone.
What the first post-cliff year did
The headline number is not the premium itself but the payment: average enrollee premium payments jumped 58% in 2026, from $113 to $178 a month, as the enhanced tax credits lapsed. The distinction matters: $178 is what enrollees actually pay after whatever subsidies remain, which is why it outruns the benchmark premium rise of 21.7% per the Urban Institute — the same sticker price, with less of it absorbed. Meanwhile average deductibles grew 37%, to around $1,027 per person, which is the number that decides whether care is usable rather than merely purchased. The coverage consequences followed the price: KFF projected enrollment falling from 22.3 million in 2025 to about 17.5 million, state-level data painted the same picture, and by late June enrollment was already down three million. Policy changes layered on top — the AMA catalogued four provisions of the 2025 budget law reshaping this year’s coverage.
What is proposed for 2027
The early filings point to more of the same: insurers proposed a median 14% premium increase for 2027, per KFF’s read of the rate filings — a touch below the 15% median at the same stage a year earlier, which is the nearest thing to good news in this dataset. Proposed rates are not final; they move during state review, and the number that matters is the one on your own letter.
The per-episode view, again
This is the individual-market version of a story we told from the employer side in the Mercer 8.2% breakdown: the cost of American coverage is compounding, and the out-of-pocket layer compounds with it. The receipts in our cost pages are the granular view of the same machine — a ~US$2,453 average payment per emergency-room visit, a US$861 average MRI — and a $178 monthly premium plus a $1,027 deductible is the recurring version of the same bill. The vloggers in the library who pay cash for the same episodes abroad are the genre that grew out of exactly this arithmetic.
The honest caveats
Three, as always. Proposed increases are filings, not invoices — final 2027 rates land state by state. Subsidies did not disappear; below the income thresholds most enrollees remain shielded, which is why the pain concentrates where the cliff bites. And a cheaper episode abroad is not an insurance plan: travel policies exclude planned treatment, follow-up care is priced where you live, and the method for reading these videos applies to premium news as much as to receipts.
One practical habit worth keeping, whoever you buy coverage from: read the plan against the episodes you actually expect, not against its monthly price alone. A deductible is a queue you pay to stand in — the same logic our NHS coverage applies to waiting lists. The per-episode prices on our cost pages exist precisely so that a $1,027 deductible can be weighed against a named, sourced price for the care behind it. Nothing here is insurance advice — but on Saturday, the numbers above are the ones to have in hand.