If you shop for health insurance through the federal marketplace at healthcare.gov, 2027 is shaping up to be the second consecutive year of double-digit premium increases. Analysis by the Peterson-KFF Health System Tracker shows a median proposed premium increase of 14% across 77 insurers in 16 states and DC, with some insurers requesting hikes above 50%. Here is what is driving costs and what South Carolina residents can do before Open Enrollment opens November 1, 2026.
Source: Peterson-KFF Health System Tracker, 2024–2025 KFF Health Tracking Poll data.
As of 2023, one or two health systems controlled all inpatient commercial hospital care in approximately 50% of U.S. metropolitan areas. That concentration gives providers leverage to demand double-digit reimbursement increases, which insurers pass through as higher premiums. Premera Blue Cross cited "double-digit reimbursement increases" in Washington state as a primary 2027 cost driver.
Source: Peterson-KFF Health System Tracker, "Eight Trends Shaping 2026 Healthcare Costs."
The 2027 Rate Picture in Context
The Peterson-KFF Health System Tracker analyzed publicly available 2027 rate filings from 77 insurers across 16 states and DC. The median proposed increase is 14% the second-highest requested rate change since 2018, following 2026’s 18% proposed increase (which finalized near 20%). The range spans 1% to 52%, with 20 insurers requesting increases above 20% and not a single insurer requesting a decrease.
These proposed rates require review and approval by state insurance departments before taking effect January 1, 2027. In past years, final rates have come in near or slightly above proposed levels. South Carolina’s finalized 2027 rates will be available on healthcare.gov when Open Enrollment opens.
Five Drivers Behind the Increases
1. Medical Costs Are Growing Faster Than Historical Norms
Insurers project underlying medical cost growth, called "medical trend", at 10% for 2027 compared to the approximately 8% historical average. Providers are requesting higher reimbursement rates due to staffing shortages, increased case complexity, and billing shifts that emerged from the pandemic period.
2. GLP-1 Weight-Loss Drugs Are a New and Growing Cost
Marketplace coverage of GLP-1 drugs like Ozempic and Wegovy has expanded rapidly. Healthfirst (New York) reported member utilization tripling from 1.6% to 5.4% in two years, with per-member costs more than tripling to $49/month. Excellus projected $28.30 per member per month in additional GLP-1 spending between 2025 and 2027. Some carriers have eliminated weight-loss GLP-1 coverage to contain costs; others pass it through as higher premiums across all members.
3. Enhanced Tax Credit Expiration Changed the Enrollee Pool
Enhanced premium tax credits, available from 2021 through 2025, expired January 1, 2026. Nationwide, enrollment fell by more than 1 million people, with healthier, lower-cost individuals most likely to drop coverage when net premiums rose. The remaining enrollees represent a higher-cost population, a shift insurers call a "morbidity adjustment." Projected morbidity impacts ranged from 4% to 7.7% in individual insurer filings.
4. Provider Consolidation Has Reduced Price Competition
By 2023, one or two health systems controlled all inpatient commercial hospital care in approximately 50% of U.S. metropolitan areas. That market concentration gives health systems negotiating leverage to demand double-digit reimbursement increases, which insurers must pass through as higher premiums. Washington state insurer Premera Blue Cross specifically cited "double-digit reimbursement increases" as a primary 2027 cost driver.
5. The No Surprises Act Added Administrative Costs
The No Surprises Act’s independent dispute resolution process, intended to protect consumers from surprise bills, has added claims processing costs. UnitedHealthcare cited a 0.8% rate impact attributable to the IDR process in its 2027 filing, a cost that flows into all member premiums.
Medicaid in South Carolina
South Carolina has not expanded Medicaid under the ACA. Most adults in South Carolina without a qualifying disability or other categorical eligibility do not qualify for Medicaid regardless of income. Adults with income at or above 100% FPL (~$15,650 for a single adult) may qualify for marketplace premium tax credits. Those below 100% FPL fall into the coverage gap and receive neither Medicaid nor ACA subsidies, a gap affecting an estimated several hundred thousand South Carolina residents.
What South Carolina Residents Should Do Before November 1
- Do not auto-renew. Open Enrollment runs November 1, 2026 through January 15, 2027. Log in and compare, your current plan’s cost structure may have changed even before 2027 rates fully apply.
- Estimate your 2027 income carefully. Subsidies are calculated on projected household income. Underestimating triggers repayment of excess credits at tax time. Overestimating means you paid more premium than you had to.
- Compare every carrier in your ZIP code. Premium differences between carriers for the same metal tier can be substantial. A plan from a different carrier may offer the same coverage for meaningfully less.
- Verify your doctors and hospitals are in-network. Carriers narrow networks to control costs. Confirm your physicians and preferred facilities for 2027 before renewing.
- Check your metal tier against your income. If your income is between 100% and 250% FPL, Cost-Sharing Reductions make Silver plans cheaper overall than Bronze despite a higher premium. Above 250% FPL, a Bronze plan may be worth evaluating if you rarely use care.
Call (713) 575-9904 for a free side-by-side comparison of 2027 plans available in your South Carolina ZIP code before Open Enrollment opens.