ACA marketplace premiums surge 20% nationwide in 2026

Population-weighted gross premiums rose approximately 20% from 2025 to 2026, according to MoneyGeek's analysis of rate filings for Silver-tier benchmark plans from all 50 states and Washington, D.C. Population-weighting means each state's average was weighted by its 2024 Census population to better reflect the national impact of rate changes.

These findings coincide with the start of 2026 open enrollment and come as Congress debates whether to extend enhanced premium tax credits set to expire at the end of 2025.

The national figure masks substantial state-to-state variation. Ten states saw health insurance premium increases exceeding 30%, while eight held increases below 10%. State policy choices (including marketplace structure, reinsurance programs and Medicaid expansion) correlate with measurably different outcomes. The findings arrive as millions of Americans shop for 2026 coverage during open enrollment.

Eleven states saw increases exceeding 30%.

At the other end of the spectrum, five states kept premium increases below 6%, with three operating state-based marketplaces.

The South bore the brunt of 2026 premium increases.

Find your state's 2026 premium change and policy context in the table below. States are sorted by percentage increase, with the highest jumps first.

MoneyGeek's statistical analysis shows consistent associations between state policy interventions and lower premium growth.

• Medicaid expansion states posted approximately 8 percentage points lower growth than non-expansion states (20.2% vs. 28.0%; medium-to-large effect, Cohen's d = −0.66).
• State-run marketplaces saw 5 percentage points lower increases compared to states using the federal Healthcare.gov platform (18.6% vs. 23.6%; medium effect, d = −0.42).
• Reinsurance programs correlate with 4 percentage points lower growth (19.2% vs. 23.3%; small-to-medium effect, d = −0.34).

These associations are correlational, not causal, reflecting multiple market factors including insurer competition, provider costs and population health. But the direction and consistency of effects across policy dimensions suggest state interventions can moderate premium volatility.

States combining all three protections (Medicaid expansion, reinsurance and a state-run marketplace) reported the most stable premiums nationwide. Together, these policies reduced average increases to the low-teens range.

Nine states haven't expanded Medicaid: Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin (partial expansion) and Wyoming. Eight of these nine saw above-average premium growth.

Roughly 92% of ACA enrollees receive subsidies that reduce out-of-pocket costs. But gross rate changes affect federal budget costs and the approximately 8% of enrollees earning too much to qualify for assistance.

Higher premiums don't guarantee better coverage. MoneyGeek's analysis of ACA claim denial rates shows insurers still reject 1 in 5 claims, leaving millions with unpaid medical bills.

Enhanced federal subsidies are set to expire on December 31, 2025. The Congressional Budget Office estimates the number of uninsured people will increase by 3.8 million on average each year from 2026 to 2034 without a permanent extension. Unsubsidized consumers (about 2.4 million nationally, often self-employed or early retirees earning just above subsidy limits) bear the full impact of gross premium increases.

States have tools to moderate growth. The 22 states with reinsurance programs saw 4 percentage points lower increases on average. States can also transition to state-based marketplaces for greater regulatory control or expand Medicaid to improve risk pools.

Federal policymakers face decisions on subsidy extensions while states continue to show that active market management correlates with greater premium stability.

MoneyGeek analyzed Affordable Care Act Marketplace premiums for 2025 and 2026 using official rate filings from all 50 states and Washington, D.C. We focused on individual-market Silver-tier plans for a 40-year-old adult, the federal benchmark for comparing premiums across states.

Data Sources

Rates for Federally Facilitated Marketplace (FFM) states came from the Centers for Medicare & Medicaid Services (CMS) QHP Landscape and Rate Public Use Files. Data for State-Based Marketplaces (SBMs) came from state marketplace filings or, where unavailable, were collected directly by MoneyGeek. Marketplace classifications, Medicaid expansion status and reinsurance program designations were verified through CMS and Kaiser Family Foundation databases.

Calculation Method

For each state, we calculated the average monthly premium for Silver plans available to a 40-year-old. Premiums were cleaned, converted to numeric format and averaged across all rating areas within each state using a simple (unweighted) mean. This approach treats all plans equally, regardless of enrollment size or region, consistent with federal benchmarking conventions.

Premiums reflect the average of all Silver-tier plans, not just the second-lowest-cost (benchmark) Silver plan used in federal subsidy calculations. This approach provides a broader view of market pricing trends and captures the full range of options consumers face when shopping for coverage.

Catastrophic, child-only and small-business (SHOP) plans were excluded.

In community-rated states (New York, Vermont and Washington, D.C.), where premiums don't vary by age, the statewide individual-market Silver rate was used and flagged accordingly. Community-rated premiums shown in tables reflect statewide rates that do not vary by age.

Statistical Analysis

We used Welch's t-tests for policy comparisons between groups with unequal variances. Effect sizes were calculated using Cohen's d. Correlations used Pearson's r. Given small sample sizes in some policy groups (particularly non-expansion states, n=9), results emphasize effect sizes alongside statistical significance.

Validation and Scope

All averages were cross-checked against CMS and Kaiser Family Foundation benchmarks and aligned within a ±2% margin. 2026 data reflect rates filed and approved as of October 2025.

Limitations

Premiums represent gross (pre-subsidy) rates. Roughly 92% of Marketplace enrollees receive federal tax credits that lower actual out-of-pocket costs. Results describe broad pricing patterns and policy correlations (such as the effects of reinsurance and Medicaid expansion) but don't establish causation.