Insurers propose price hikes for Affordable Care Act exchange plans Prices

Illinois consumers may face sticker shock when they shop for health insurance plans on the state’s Affordable Care Act exchange this fall — with most companies proposing double-digit-percentage price increases as they grapple with uncertainty about changes at the federal level.

Blue Cross and Blue Shield of Illinois, which has 238,000 Illinois residents on its exchange plans, is proposing an average rate increase of 27% across its individual exchange plans in Illinois.

UnitedHealthcare of Illinois, which has about 32,000 Illinois residents on its exchange plans, is proposing an average rate increase of nearly 21%.

Celtic Insurance Co.’s most recently submitted proposal would raise rates by an average of nearly 39%. Celtic has about 111,000 Illinois residents on its Ambetter exchange plans.

Several insurers are also pulling out of the exchange in Illinois for 2026. Aetna CVS Health, Health Alliance and Quartz will no longer offer exchange plans in Illinois next year, and Cigna Healthcare of Illinois will no longer sell marketplace plans in Cook County, though Cigna plans will be available in other parts of the state.

In filings with the state, insurance companies blamed the price increases on growing health care costs and increasing use of health care services. They also assumed in their calculations that enhanced tax credits that many people now use to help lower their monthly premiums for exchange plans will expire at the end of this year — a situation that experts say would likely cause some healthy individuals to forgo insurance altogether, driving up costs across the board.

Some insurers also mentioned a new federal rule that will shorten the annual open enrollment period for exchange plans. UnitedHealthcare of Illinois said uncertainty surrounding tariffs on pharmaceuticals also affected proposed rates.

Blue Cross and Blue Shield of Illinois said in a statement to the Tribune that the proposed rates “reflect industry-wide changes to the market.” UnitedHealthcare of Illinois and Centene Corp., which is behind Ambetter plans in Illinois, did not provide comment.

“At the end of this day, all of this policy uncertainty that’s driving up premiums for the next year, the consumer is the one who’s going to have to face those prices, they’re the ones who are going to have to front that money,” said Matt McGough, a policy analyst in KFF’s Program on the Affordable Care Act. KFF is a nonprofit organization focused on health policy.

The Illinois Department of Insurance placed the blame for the higher rates squarely on President Donald Trump.

“Driven by Trump’s harmful budget bill that’s kicking people off Medicaid, making insurance less accessible, and exacerbating America’s already broken healthcare system, states across the nation — including Illinois — are facing significant increases in insurance premiums through the marketplace,” the department said in a statement. “Trump’s harmful policies will result in more uninsured Americans, which drives up costs up for everyone.”

In a statement, however, the federal Centers for Medicare and Medicaid Services blamed former President Joe Biden. The statement said that under Biden, uncertainty for insurers increased because of policies that led to more people enrolling in exchange plans and because the exchange’s eligibility and verifications systems were weakened, which “led to massive amounts of fraud and improper enrollments.”

“CMS remains committed to ensuring coverage under the Affordable Care Act remains accessible, affordable, and actuarially sound,” according to the statement.

In Illinois, a record 466,000 people signed up for exchange plans this year, according to KFF. Most people in Illinois get health insurance through their employers, Medicare or Medicaid. The Affordable Care Act exchange provides an option for people who don’t get insurance through employers and who don’t qualify for Medicaid or Medicare.

Illinois residents may begin signing up for plans at the beginning of open enrollment Nov. 1 on the state’s new exchange at GetCoveredIllinois.gov. Illinois recently gained approval from the federal government to transition to a state-run exchange rather than use the federal one at HealthCare.gov.

Illinois regulators must still approve the proposed rates before they’re finalized. In 2023, Gov. JB Pritzker signed a bill into law giving Illinois regulators the power to reject or modify proposed price increases for individual and small business health insurance plans, such as those sold on the exchange, if they deem them “excessive, unjustified or unfairly discriminatory.” A spokesperson for the state insurance department said in an email Thursday the proposed rates are still being evaluated.

The proposed price increases in Illinois follow a national trend. Premiums for exchange plans across the country are expected to rise by a median of 18% for next year for many of the same reasons cited by companies selling insurance in Illinois, according to an analysis by the Peterson-KFF Health System Tracker. It’s the largest proposed rate increase since 2018, according to the analysis.

“Insurers are setting 2026 premiums amid this fog of uncertainty,” McGough said. “They’re unsure what policies will be passed, what will the marketplace look like next year, so a lot are building in these price hikes to play it safe and be conservative.”

One of the biggest uncertainties is whether Congress will vote to extend enhanced tax credits that many people use to lower their monthly premiums. Many people who choose exchange plans have long qualified for the tax credits based on their income. Those subsidies were expanded with the passage of the American Plan Rescue Act in 2021 and then extended through 2025 by the Inflation Reduction Act.

But it’s now unclear whether the Republican-controlled Congress will vote to extend those enhanced subsidies beyond this year. Many Republicans have long criticized the Affordable Care Act as flawed and too costly, and Trump famously tried to eliminate it in his first term.

If Congress does not extend the enhanced subsidies, many people will still likely receive tax credits but they may be smaller than the credits they get now. Others who make larger amounts of money may no longer get the credits at all.

The expiration of those enhanced tax credits would likely drive some healthier people away from exchange plans, experts say. People who are healthy may decide having health insurance isn’t worth the higher cost.

Healthy people are cheaper for health insurance companies, and the companies rely on their participation to help balance out the costs of insuring sicker people. KFF estimated in 2024 that if the enhanced subsidies expire, premium payments for exchange plans in Illinois would rise by 61%.

“In an era of rising costs across the board … this is not going to help,” Stephanie Altman, director of health care justice and senior director of policy at the Shriver Center on Poverty Law in Chicago, said of the higher costs.

“It’s going to just add to that household pressure, and I think unfortunately we may see people having to bow to that pressure and not be able to keep their health insurance in the marketplace, especially the people who really need to be in the marketplace, younger people, people who are healthier to balance that risk pool and keep costs down,” Altman said.

Still, Altman said, even with the higher rates, it’s worth it for consumers to see how much different plans might cost. Many people are surprised by how much financial assistance they can receive in the marketplace, she said.

McGough said people might want to consider buying cheaper plans on the exchange, such as bronze-level plans, which have lower monthly premiums but higher out-of-pocket costs for medical services.

Illinois residents may also see more opportunities for assistance enrolling in exchange plans this year, Altman said.

On Oct. 1, Get Covered Illinois is launching a customer assistance call center and a new version of its website, GetCoveredIllinois.gov, where people will be able to shop for plans. Also, last year Illinois committed to spending $6.5 million on navigators to help people enroll in plans, according to the Illinois Department of Insurance.

“Operating a state-based marketplace will allow our state more flexibility to provide health insurance coverage that is tailored to the needs of our residents,” Pritzker said in a news release earlier this month.

By operating its own exchange, Illinois should also have an easier time helping people move between Medicaid and exchange plans, as their income changes, Altman said. And Illinois may be able to open up more special enrollment periods, allowing more people to sign up for coverage at times other than open enrollment.