Brace for sticker shock if you're buying health insurance on the ACA marketplace

If you are one of the 617,000 people in Missouri or Kansas buying health insurance on healthcare.gov, expect sticker shock when next year's premiums are announced.

With few exceptions, insurance companies selling health coverage through the Affordable Care Act marketplace plan to increase rates in 2026. In the Kansas City area, all but one carrier have asked Kansas and Missouri regulators for the right to bump up premiums — in one case by 40%.

Only Blue Cross and Blue Shield of Kansas City proposed a decrease.

The story is similar across the country.

A survey of proposed rates by KFF and the Peterson Center on Healthcare found a median planned increase of 18% among the 312 insurers participating in ACA marketplaces nationwide. That is 11 percentage points higher than last year and the steepest increase request since 2018.

Only four insurers nationwide said they would decrease rates.

According to the KFF report, insurance companies cited numerous reasons for the increases, including inflation, increasing labor costs and the high price of specialty drugs like GLP-1 weight loss medications.

But health policy experts said much of the blame should fall on new Trump administration laws and policies that will increase the cost of marketplace coverage, drive healthy people to drop out and leave behind patients who cost the most.

Expiring tax credits and new rules

The first policy that will drive up prices is that enhanced tax credits are expected to expire.

Since 2021 those tax credits have offset the cost of health plans for more than 90% of people enrolled in the ACA marketplaces and made coverage more widely available. The tax credits, which helped double marketplace enrollment between 2021 and 2025, expire at the end of the year if Congress doesn't renew them.

The second policy driving up prices involves a new Centers for Medicare and Medicaid Services rule that overhauls how the marketplace operates.

Some changes will make it harder for people to enroll and keep coverage, such as shortening the enrollment period, eliminating automatic reenrollment and adding stricter eligibility checks. Other changes upend how insurance payments are formulated, which could drive up premiums and force people to pay more for deductibles and copays.

"The bottom line is that out-of-pocket premiums will go up," said Gideon Lukens, senior fellow at the Center on Budget and Policy Priorities, who co-authored a report about the changes. "People will pay higher deductibles and copays, and the maximum out-of-pocket limits will also go up. … And then a lot of people lose coverage as a result."

Comparable to repealing Obamacare

The ACA marketplace reached more than 24 million enrollees nationally in 2025, including 417,000 in Missouri and 200,050 in Kansas. That was a record, and double the enrollment in 2021 when enhanced tax subsidies first went into effect. During that same period, Missouri's enrollment also doubled, while Kansas' climbed 133%.

But those enrollment highs are widely expected to plummet next year as premiums increase. In a recent report, the Kansas Health Institute predicted that Kansas ACA enrollment could immediately return to 2021 levels and uninsured rates could "greatly increase."

Anything that makes insurance harder to get — and especially more expensive — leads to fewer people being covered, experts said.

And next year's potential insurance premium increases come as the Congressional Budget Office predicts that policy changes from the Trump administration will lead to an annual decline in overall resources for the country's poorest households between 2026 and 2034. The CBO said poor households will lose an average of $1,200 annually during the period, while top-income households can expect to gain $13,600.

Lukens said increased health insurance premiums caused by the expiration of enhanced tax credits and CMS rule changes could effectively lead the country back to a time before the ACA was adopted, when many people couldn't afford insurance and found it difficult to access health care.

"It's not a repeal of the ACA, but the size of the impact is comparable," he said. "The way it's done is more of a death-by-a-thousand-cuts way — a lot of changes that will just generally add a lot of red tape and make it harder for people to keep coverage, to enroll in coverage, and will raise costs. But the overall impact of it will be to increase the number of people without coverage by getting close to where we were before the ACA."

Millions are expected to lose health coverage through the Affordable Care Act marketplace if Congress doesn't act. (Vaughn Wheat/The Beacon)

A vicious cycle

Once the dust settles, an estimated 8 million people are expected to lose coverage through the ACA marketplace. On top of that, 9 million could lose Medicaid under federal legislation passed in July, which cuts federal spending on the program by close to $1 trillion and adds new obstacles to keep coverage, like work requirements and documenting hours worked.

"The worst case scenario here is bad," said Caitlin Donovan, a spokesperson for the Patient Advocate Foundation, which helps people around the country with chronic and life-threatening illnesses find care. "It's really bad."

Ultimately, she said, when people lose health coverage they're less likely to seek care and more likely to get sicker before getting help. That makes care cost more, puts more strain on hospitals and other health care providers and, ultimately, continues the cycle of insurance rates climbing.

"There is going to be a sicker population that's in a much worse situation," Donovan said.

When people who are young and healthy don't participate in the insurance market, leaving behind people who are more expensive to cover, it can trigger a cycle of increasing premiums, said Christopher Garmon, assistant professor of health administration at the University of Missouri-Kansas City.

"Anything that makes healthy people less likely to enroll is going to increase costs and cause premiums to go up, and make healthy people less likely to enroll," he said. "And that is a vicious cycle."

ACA premium changes will vary based on where a person lives, their age and income. KFF has a calculator that can help people know how much they may see rates increase come January.

The Commonwealth Fund estimates that people in Missouri who receive tax credits will see a $720 jump in annual premiums, while the same group in Kansas will see a $590 annual increase.

Rising premiums in Kansas and Missouri

Most of the insurance companies in the Kansas and Missouri marketplaces have requested premium increases next year.

In Kansas, Celtic Insurance Co. proposed a 40% increase, the highest jump. But Medica Insurance Co. said its rates need to go up 29.3% in Kansas. In Missouri, Medica proposed an increase of 29.2%, while Celtic proposed a jump of 24.4%.

Celtic could not be reached for comment.

Medica provided a written statement, saying the company's rate request "reflects the trend toward increased use of medical services as well as the expiration of enhanced subsidies for those who depend on the Affordable Care Act marketplace for coverage."

"We urge the Congress to promptly extend assistance that promotes stability in this vital market serving millions of Americans," the Medica statement said.

Other carriers in the Kansas City market proposing rate increases include Oscar Insurance Co., which is asking for a 14.4% increase in Kansas and an 11.7% increase in Missouri, and United Healthcare Insurance Co., which wants a 10.1% bump in Kansas and a 10.7% increase in Missouri.

Blue Cross and Blue Shield of Kansas City is the only carrier in the market — and one of just four in the country — planning to lower rates next year.

The company said it would drop rates 6.1% in Kansas and 4.4% in Missouri.

In a written statement, Rachel Arnett, Blue Cross vice president of sales, said the company had "evaluated our product offerings, gathered feedback from our customers, and developed a variety of options on the ACA Marketplace for health insurance in 2026."

Those include "a new focused provider network," which it said would bring lower premiums and predictable cost, and plans to offer its primary care model, Spira Care Access, through nine area centers.

A spokesperson for the carrier declined to answer questions about the rate reduction and did not provide other details about the scope of the coverage.

Less help available

Proposed rates must be approved by state insurance regulators before they are officially listed in the marketplace.

That should happen this fall in time for the ACA marketplaces' open enrollment period, which begins Nov. 1. This year, people will have until Jan. 15 to complete enrollment. But next year that window will shorten to Nov. 1 through Dec. 15.

But many people may not realize how much the ACA will be changing next year or understand what options they may have for coverage. That's because earlier this year the Trump administration cut funding for navigators who help people find health insurance through the ACA marketplace or, if they qualify, Medicaid.

Funding for public information campaigns about ACA coverage and the open enrollment period has also been cut, meaning some enrollees could miss deadlines or forget to reenroll, which could also add to the number of uninsured.

Justin Gust, vice president of community engagement with El Centro Inc., said he's seen this play out before. The last time Trump was in the White House virtually all of the funding for public information campaigns was eliminated. And the consequences were not good.

"There was a huge reduction in people enrolling," he said.

This story was originally published by The Beacon, an online news outlet focused on local, in-depth journalism in the public interest.