ACA marketplace plans seeking double-digit premium increases for 2026

The 24 million Americans who obtain health insurance through the Affordable Care Act marketplace will have to dig deeper into their pockets for coverage next year.

Insurers are proposing the highest premium increases in five years, with a median premium hike of 15%, according to an analysis for the Peterson-KFF Health System Tracker covering 19 states and the District of Columbia.

Compare this to 2025, when health insurers had a median proposed increase of 7%.

Insurers who sell coverage on the ACA exchanges are facing headwinds from two sources: rising costs and usage, and uncertainty over whether Congress will allow COVID-19-era ACA tax subsidies to expire at the end of 2025.

These are initial numbers and insurance commissioners in some states may alter requests before approval.

Still, “it’s the biggest increase we’ve seen in over five years,” said analysis co-author Cynthia Cox, a KFF vice president and director of its Program on the ACA.

Premiums will vary based on where consumers live, the type of plan they choose, and their insurer.

The KFF report said several factors are driving proposed premium increases. For example, insurers say underlying medical costs — including the use of expensive obesity drugs — will add about 8% to premiums for next year. And most insurers are also adding 4% above what they would have charged had the enhanced tax credits been renewed.

Tariffs also could be a factor in higher proposed premium, KFF said. Tariffs could drive up the cost of some drugs, medical equipment and supplies. Some insurers report that tariffs — and the uncertainty around them — are driving rate increases about 3% higher than they otherwise would be.

Future of enhanced ACA tax credits in question

A big question in all this is whether Congress decides to extend more generous tax credits first put in place during President Joe Biden’s term as part of the American Rescue Plan Act in 2021, then extended through the Inflation Reduction Act in 2022.

Those laws raised the subsidy amounts people could receive based on their household income and local premium costs and removed a cap that had barred higher earners from even partial subsidy assistance. Higher earners could still qualify for some subsidy but first had to chip in 8.5% of their household income toward the premiums.

Bigger subsidies helped fuel record enrollment in ACA plans, especially among lower-income policyholders.

But those enhanced subsidies are also costly. A permanent extension could cost $335 billion over the next decade, according to the Congressional Budget Office.

Consumers will learn their new premium prices only late in the fall, or when open enrollment for the ACA begins on Nov. 1 and they can start shopping around.

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