Rising ACA premiums signal new pressures on providers: How to prepare

Providers certainly do not need any new financial pressures. Unfortunately, they are coming.

Insurance provided through the Affordable Care Act (ACA) marketplace is expected to increase by 26% for 2026 plans—the largest rate hike since its launch. That's the average. In the 32 states using Healthcare.gov, those premiums are expected to rise upwards of 30%. Even worse, some enrollees could see their premium payments more than doubleif the enhanced premium tax credits expire at the end of 2025.

Bottom line: the cost of care is going to dramatically increasefor many, and patients will be taking on more payment responsibility. At a time when copays account for the highest percentage of bad debtfor healthcare organizations, providers must get out in front of the patient collection challenge by implementing five key strategies for their ACA-insured patients.

1. Map the new patient journey early

Traditional billing practices lack patient empathy and are notorious for creating confusion and frustration. In contrast, a patient-centric approach ensures financial clarity and transparency at every stage of the patient journey.

The changes coming for those insured in the ACA marketplace will likely result in unwanted financial surprises. Providers should acknowledge this up front and treat these enrollees as a distinct group that needs special attention. Then they can implement proactive strategies that prioritize clear communication around coverage limits and cost expectations.

2. Segment and communicate proactively

With higher out-of-pocket costs coming, price transparency and the ability to provide accurate estimates upfront will be more important than ever. Providers need tools that will support segmentation of those currently insured in the ACA marketplace and those newly insured, as well as timely means of communicating financial responsibility and payment options.

Automation plays a key role in the effectiveness of these strategies as manual processes are often a non-starter in today's leanly staffed provider organizations. Any communication method should meet patients where they are, addressing both education level and native language, as well as making information available in a variety of formats, whether text-based, email or phone.

Once patients receive notification of copay estimates, staff readiness is essential. Patients will look to them to discuss payment options including payment plans or financial assistance that may be available. The reality is that patients are much more likely to follow through with payment if they understand their financial obligations and options.

3. Go digital with payments and billing

Digital payment innovation is one of the most effective ways to improve collection rates and speed revenue cycle because it helps eliminate confusion. Given that the majority of consumers prefer digital billing and payment options, providers should invest in tools such as mobile statements, text reminders and online payment plans to improve both collection rates and patient satisfaction. The good news is that when patients opt for digital communications, providers win on the operations front, both in terms of more efficient use of staff time and the costs associated with generating and mailing paper bills.

While digital offerings are important, patient preference should remain at the forefront of strategy. Consequently, digital tools may need to coexist with paper statements and payment. They key is to incorporate patients' preferences into communications by asking them early in their financial journey how they would like to be notified about their balance.

4. Automate to protect cash flow

Shoring up reconciliation processes will be critical to staying ahead of increased patient financial responsibility. Deploying reconciliation and payment-acceleration tools to reduce days in A/R and streamline back-office work is an important step forward. When payment reconciliation is automated, providers can match incoming electronic payments to invoices to improve accuracy and speed processes.

Equally important are advanced platforms that reconcile both payer-collected and direct patient payments. While patients are increasingly looking to easy payment options such as insurance portals and health savings accounts (HSAs) to make their copays, provider organizations often have to wait weeks to receive funds. Automation ensures these payments are transferred immediately to a provider's bank and reconciled within existing provider systems, as opposed to receiving a check or virtual card outside of the EHR.

5. Reevaluate collection policies

Rising out-of-pocket costs demand new approaches to outdated, manual billing processes that lack patient empathy and engagement. Sustainable financial health now depends on meeting patients where they are via flexible payment options, early-out strategies and clearer financial education. When patients have clarity at every step of their financial journey, providers can foster trust, improve outcomes and build loyalty.

Many patients may be caught off guard by coming increases associated with ACA premiums. Providers who acknowledge that increased financial pain and take action will be best positioned to help patients navigate changes as well as collect balances owed. From transparency into pricing and copays to personalized communications and flexible payment options, the future of patient-centric billing will prioritize educating, engaging and empowering patients.

Tom Furr is the CEO of PatientPay