Higher premiums, Medicare updates: Healthcare changes to expect in 2026

Higher premiums, Medicare updates: Healthcare changes to expect in 2026

In 2026, higher costs along with major shifts in Affordable Care Act (ACA) coverage and Medicare will affect healthcare and health insurance affordability. Here, GoodRx, a platform for medication savings, breaks down what's changing.

Key takeaways:

* Expect higher premiums for your health insurance, regardless of type, in 2026.

* More people are expected to opt out of insurance — including Affordable Care Act plans because of enhanced premium subsidies that expired — while seeking cash-pay healthcare.

* Medicare has many changes, including higher costs, an original Medicare prior authorization pilot program in six states, and an option to change Medicare Advantage plans if a provider directory error guided your choice.

What are the major healthcare changes in 2026?

Anyone who needs healthcare, with or without health insurance, can expect changes in 2026. From higher costs to new avenues for access, healthcare is expected to work differently for many people in 2026.

Here are some shifts that might apply to you:

* Higher insurance premiums: Expect to pay more for health insurance in 2026, whether you have employer-sponsored insurance, Medicare, Medicaid, or some other type of coverage.

* Higher hospital costs: Many hospitals, outpatient surgery centers, and doctor's offices will charge more. And you may start noticing a pass-through of costs, such as facility fees.

* Opting out of insurance: Some people will decide to go without insurance, which will lead them to self-pay options and other ways to access care.

* Fewer people with ACA plans: There is slightly lower enrollment in ACA plans, dropping from more than 24 million in 2025 to less than 23 million in 2026 as of January. This is likely because of higher premiums and the expiration of enhanced subsidies that dropped many people's premiums to $10 or less. Enhanced premium subsidies drove record enrollment for the previous four years.

* Many Medicare changes: In addition to the Medicare Part D out-of-pocket maximum increasing to $2,100, a six-year pilot program will test prior authorization for original Medicare enrollees in six states for certain Part B items and services beginning Jan. 1, 2026. There's also a new special election period in 2026 to choose another Medicare Advantage plan if you relied on an incorrect directory in the Medicare Plan Finder online tool to select your coverage.

Will your premiums or out-of-pocket costs increase in 2026?

Most likely, yes. A survey of more than 1,700 U.S. employers found that paycheck deductions for premiums were expected to increase 5% to 6% in 2026 compared to 2025. For small employers, the premium hikes were estimated at 11% on average in an analysis of 318 businesses with 50 or fewer employees.

The reasons for higher premiums include:

* More people accessing care, such as mental health services and for earlier-onset cancer cases

* More costly treatments, such as GIP and GLP-1 agonists to treat Type 2 diabetes and weight loss, cancer medications, and other specialty drugs that deliver better outcomes

* Higher hospital costs

How is ACA marketplace coverage changing in 2026?

ACA coverage will be more costly for most people. And some noncitizens who are present in the U.S. legally will lose access to marketplace plans. Many of the changes come as a result of the One Big Beautiful Bill Act of 2025. Here are some of the changes:

* Plans will cost more. Over the last few years, most people with ACA plans qualified for enhanced premium tax credits that lowered their monthly costs for coverage. Without those enhanced subsidies, which expired on Dec. 31, 2025 and may not be revived by Congress for 2026, most enrollees will end up paying higher premiums.

* There's no tax-liability cap anymore. Premium tax credits are most often provided in advance, based on an enrollee's estimate of their income at the beginning of the year. If their income at year's end exceeds their estimate, the enrollee may need to repay the tax credit. Previously, there was a limit on how much someone needed to repay — despite the difference in estimated and actual income. But now there's no cap, and enrollees could face significant payback amounts.

* There's no more low-income rolling enrollment. The One Big Beautiful Bill Act eliminated a continuous special enrollment period (SEP) for people with incomes below 150% of the federal poverty line. In 2026, you can still have a SEP for a qualifying life event such as loss of coverage, a new child in the household, or marriage — and be eligible for premium tax credits. But you can no longer enroll during a SEP based on income and qualify for premium subsidies.

* Some noncitizens will be blocked from coverage. Already ineligible for Medicaid, some lawfully present immigrants also will not qualify for premium tax credits. This will make ACA plans unaffordable for many refugees, asylees, and those with Temporary Protected Status. Access to ACA coverage for people with Deferred Action for Childhood Arrivals (DACA) status ended in 2025.

How to prepare for healthcare changes in 2026

How to best prepare for healthcare changes in 2026 will depend on your health insurance status. First, we'll review what to consider if you have insurance, and then we'll provide tips for people who won't have coverage in 2026.

If you will have insurance

If you have insurance in 2026, it's important to know what every plan you have covers and your expected cost-sharing, such as deductibles, copayments, and coinsurance. In addition to comprehensive health insurance, you also may have a:

* Prescription plan, such as Part D for people with Medicare

* Dental plan

* Vision plan

* Supplemental insurance, such as Medigap (if you have original Medicare)

* Tax-advantage healthcare account, such as a flexible spending account (FSA), a health savings account (HSA), or a health reimbursement arrangement (HRA)

If you won't have insurance

Even if you don't have health insurance coverage, there are some alternative ways to access care, such as:

* Direct primary care: Direct primary care (DPC) lets you make appointments and make out-of-pocket payments directly with a healthcare professional. Your DPC arrangement typically includes routine care, management of chronic conditions, acute-care visits, and care coordination. But it doesn't include emergency and hospital services.

* Cash-pay care with a good faith estimate: If you're not using insurance to pay for care, you are entitled to a good faith estimate (GFE) or an itemized list of expected costs for a scheduled service. You can dispute the bill if it's at least $400 over the GFE.

* Concierge care: Concierge care is a membership-based model that often comes with a yearly retainer fee that gives you direct access to a physician. Concierge care offices often limit the number of patients, while offering same-day and longer appointments than typical practices. Concierge care routinely attracts higher-income consumers and may also be called concierge medicine, retainer-based medicine, a platinum practice, or boutique medicine.

* Medical cost-sharing: Sometimes called healthcare sharing plans, medical cost-sharing programs are communal models where members pool their money to cover everyone's approved medical costs. Medical cost-sharing programs are not insurance, and member costs may not be paid. There are financial risks, and members can end up with unpaid bills, leading to hefty medical debt.

* Cash care: There are healthcare facilities and other convenience locations that have transparent and/or flat-free pricing for services. Locations include retail clinics — often found in pharmacies or grocery stores — and urgent care centers.

* Sliding-scale care: Care at community clinics is typically low cost, but not free. There are also other free and low-cost healthcare options available nationwide. You typically pay on a "sliding scale" based on your income and other factors.

* Patient assistance programs: If you don't have insurance, you can qualify for free healthcare and prescription medications from patient assistance programs.

* Charity care: Also known as indigent care, this is a type of financial assistance that provides deep discounts for your medical bills. You may qualify if you're medically indigent, which means medical bills make up a significant share of your income, and medical debt threatens your financial stability. You're financially indigent when you're uninsured or underinsured, and your household income falls below a certain threshold. Nonprofit hospitals are legally required to offer charity care, and some for-profit hospitals do also.

Medicare changes in 2026

Medicare changes in 2026 include:

* Higher Part A and Part B deductibles, as well as a Part B monthly premium that has increased by nearly $18 a month compared to 2025 — almost 10% higher — from $185 to $202.90.

* A Part D prescription plan out-of-pocket cap that increased from $2,000 in 2025 to $2,100 in 2026. After you spend that much, your Part D plan pays 100% for covered medications for the rest of the year.

* Prior authorization for certain Medicare Part B services and items received in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. The Part B services and items subject to these coverage denials have been deemed potentially wasteful and prone to fraud by the federal government. The pilot program only applies to original Medicare enrollees and doesn't apply to Medicare Part D plans, which already use prior authorization and step therapy.

* The Medicare Prescription Payment Plan, which debuted in 2025, gives anyone with Medicare prescription coverage the option to make payments for out-of-pocket costs instead of spending up front at the pharmacy. This program continues in 2026, and participation is still voluntary. But if you signed up in 2025, now you will be automatically renewed for participation unless you opt out.

* The 2026 coverage year is the first time the Medicare Plan Finder online tool has included a provider directory for each Medicare Advantage plan. This information is helpful for people who have preferred healthcare professionals and medical facilities. But the directory may contain flawed information, including healthcare professionals and facilities no longer in network. If you chose coverage with Medicare Plan Finder information based on a directory error, you can be eligible for a special election period to choose a different Medicare Advantage plan. You must catch the issue within three months of the coverage beginning and call 1-800-633-4227 (1-800-MEDICARE) for assistance.

Were any Medicare Advantage plans dropped in 2026?

Most Medicare enrollees have fewer Medicare Advantage options in 2026. Medicare enrollees will be able to choose from an average of 32 standard Medicare Advantage plans with Part D coverage and seven standard Medicare Advantage plans without Part D for the 2026 coverage year. (These figures exclude special needs plans and other specialty coverage options.) In 2025, the average enrollee could choose from 34 standard Medicare Advantage plans with Part D and eight standard Medicare plans without Part D.

The bottom line

Higher costs dominate the changes associated with health insurance in 2026. This extends beyond expired Affordable Care Act enhanced premium subsidies to higher costs for people covered by Medicare, Medicaid, and employer-sponsored plans. The shift is so profound that many more people beyond the year-in-year-out uninsured are expected to skip insurance coverage in 2026 because of cost. If you end up without coverage, you have many self-pay options that can be affordable for you.

This story was produced by GoodRx and reviewed and distributed by Stacker.