The news: A new analysis published October 20, 2026 by Live Insurance News frames the starkest contrast yet in 2027 ACA rate filings: Vermont regulators held 2027 health insurance increases to about 3% — the lowest confirmed final rate in the country — while Arizona insurers have proposed a weighted-average increase of about 29%, the highest. Nearly every other state falls in between, with Alabama (25%), New Mexico (24.4%), and Kansas (24.2%) clustering near the top. Open enrollment starts November 1, so this is the number that will set your 2027 bill.
The gap is not a quirk of the data. It reflects a genuine difference in how states regulate insurance. Vermont's Green Mountain Care Board has binding authority to cut insurer rate requests and control hospital budgets; most high-increase states have neither. Whether your state approves a 3% bump or a 29% one may come down to which of these two systems you live under.
In this guide
The gap, in brief: every state on one scale
The 2027 filing season is roughly half finalized, and the shape is clear. According to data compiled by healthinsurance.org and reported across trade press, the national median proposed increase is about 15% — already steep. Vermont anchors the low end at roughly 3%; Arizona anchors the high end at 29%. Key confirmed and proposed figures:
- Vermont: ~3% weighted average, final (Green Mountain Care Board orders).
- Iowa: 5.7%, final. New York: 6%, final. Utah: 6.7%, final.
- Montana: 22.6%, final. South Carolina: 22.1%, final. New Mexico: 24.4%, final.
- Kansas: ~24.2%, proposed. Alabama: 25%, final. Arizona: ~29%, proposed.
Note the "proposed" caveat: Arizona's 29% and Kansas's 24.2% are weighted averages of what insurers requested and could be trimmed in review. Vermont, Alabama, New Mexico, and Montana are final — those numbers are locked in for 2027.
Why Vermont's number is so low
Vermont's result starts with a body most states do not have. The Green Mountain Care Board (GMCB), a five-member independent regulator, has binding authority over health insurance rates. Insurers cannot simply file and proceed: the board reviews every request, holds public hearings, examines the actuarial data, and can — and does — reduce proposed increases. This year, the two marketplace insurers asked for increases averaging around 15%; the board cut those requests by 2.9 to 4.3 percentage points each. Blue Cross Blue Shield of Vermont's individual plan landed at about 2%; MVP Health Care's at just under 4%. Per Vermont Biz, the board's decisions are expected to save Vermonters roughly $24 million versus what insurers requested.
The board also controls the other side of the equation: hospital costs. Vermont hospitals submit annual budget requests that the GMCB reviews and can cut, so rising provider prices do not flow straight through to premiums. Vermont's 2025 Act 68 adds reference-based pricing, tying what insurers pay non-Medicare hospitals to a percentage of Medicare rates. Blue Cross Blue Shield of Vermont credited a switch from brand-name drugs to cheaper alternatives as one factor that lowered its 2027 request before review even began.
Arizona's 29%: who's up, and by how much
Arizona is the outlier at the very top of the national list. Per healthinsurance.org's per-carrier breakdown of proposed 2027 individual-market increases, nearly every Arizona insurer filed for a double-digit jump:
- Oscar Health Plan: 33.9% proposed — the highest in the state.
- Imperial Insurance: 30.1% proposed.
- Blue Cross Blue Shield of Arizona (HMO): 29.6% proposed (BCBSAZ's own rate filing cites anticipated utilization and provider fee increases).
- UnitedHealthcare of Arizona: 28.6% proposed.
- Arizona Complete Health: 24.6% proposed.
- Antidote Health Plan of Arizona: 3.3% proposed — the lone modest filer.
Arizona also loses a carrier: Cigna is exiting the Arizona marketplace at the end of 2026, so Cigna enrollees must pick new coverage during open enrollment or face a gap. Roughly 260,000 Arizonans are enrolled in ACA marketplace plans, and the filing documents suggest average per-enrollee premiums could approach roughly $890 a month before subsidies.
What this means for you
The national backdrop is rough everywhere. With the enhanced federal premium tax credits expired at the end of 2025, the full-price premium is what sets your baseline — and filings for 2027 average in the mid-teens nationally, on top of last year's roughly 20% median. Two double-digit years in a row means typical marketplace premiums are up by more than a third since 2025. Subsidies are still available to most enrollees (about 87% of 2026 enrollees qualified), and they are designed to rise with the benchmark Silver plan — but households earning above 400% of the federal poverty level absorb the increase with no cushion.
Auto-renewal is the most expensive choice in a high-increase state. If you are in Arizona, Alabama, New Mexico, Kansas, or the other 20%+ states, your 2027 premium will be dramatically higher than 2026 unless you actively shop. Insurers must send rate-change notices, but those notices are easy to miss — log in and compare plans side by side rather than letting the system roll you into next year.
Regulation matters, and it varies wildly. Vermont shows that binding rate review plus hospital budget oversight can hold increases to a third of the national median. New York's prior-approval regime landed it at 6% final. If your state approves 25% without much of a fight, that is a policy choice — and a reason to budget for double-digit increases as the norm, not the exception, until something changes.
What to do before January 15
- Do not auto-renew. In a 29% state, passive renewal is the costliest option. Compare your current plan against every option on Healthcare.gov or your state exchange — carriers filed very different increases, and one carrier (Antidote in Arizona) barely moved.
- If you have Cigna in Arizona, act early. Cigna's exit means you must actively choose a new carrier during open enrollment; waiting until the deadline risks a rushed decision or a coverage gap.
- Recheck your subsidy eligibility. Even with the enhanced credits gone, standard premium tax credits still cushion the benchmark Silver plan for most enrollees. Run your numbers with our health insurance subsidy estimator before you shop, and update your income estimate if anything changed in 2026.
- Mind the December 15 deadline. Open enrollment runs November 1, 2026 to January 15, 2027 — but to have coverage starting January 1, you must enroll by December 15.
- Check whether your doctors and prescriptions are still covered. With carriers exiting and narrowing networks in several states, the cheapest premium is a bad deal if your doctors left the network. Our coverage of Oregon's 2027 increases and two carrier exits has a playbook for when your carrier leaves the market.
- Track your own state's final number. Arizona's 29% is still proposed — your state regulator may trim it. Similar state-level announcements are rolling out weekly; our North Dakota 2027 rate guide shows how commissioner review can shave points off insurer requests.
Frequently asked questions
Is Arizona's 29% increase final?
No — it is a weighted average of proposed rates filed by insurers for 2027, compiled by healthinsurance.org. Arizona regulators can still approve lower figures. Watch for the final approval; some states have trimmed proposed double-digit hikes in review, as North Dakota did this year.
Why is Vermont's increase so much lower?
Vermont's Green Mountain Care Board has binding authority to review and cut insurer rate requests, and it also approves hospital budgets — limiting how much provider price increases flow through to premiums. For 2027 it cut the two insurers' requests by 2.9 to 4.3 percentage points each. Most states do not have an equivalent body.
Will my premium actually rise 25–29% in a high-increase state?
Not necessarily — 29% is the average full-price increase before subsidies, and your actual bill depends on your plan, age, and county. Most marketplace enrollees qualify for premium tax credits, which rise alongside benchmark plan prices and can absorb part of the jump. The surest way to know is to compare plans on your exchange during open enrollment.
When is ACA open enrollment for 2027?
Open enrollment runs November 1, 2026 through January 15, 2027 in most states. Enroll by December 15, 2026 for coverage starting January 1, 2027.