Texas ACA insurers hike monthly premiums 35% Texas ACA insurers hike monthly premiums by 35% on average

Affordable Care Act premiums are set to rise by 35.2%, on average, in Texas when open enrollment begins Nov. 1, a consequence of the insurance industry's response to rising costs and the likelihood of expiring premium tax credits.

The sticker shock from this percent increase will be more pronounced in Texas than in all but five states. An average benchmark monthly premium - the premium for the second-lowest cost silver plan, which is used to calculate the size of tax credits - for a 40-year-old individual was $489, before tax credits are applied, for 2025; health policy organization KFF found that Texas insurers are charging ACA enrollees $661 for benchmark plans, on average, in 2026. That was the biggest percentage change since 2018.

The organization also found average premiums increased faster among states that use Healthcare.gov, like Texas, compared to states that operate their own state-based exchanges.

The amount that individuals pay toward their premiums would rise more steeply than the underlying rate hike because of the expiration of the enhanced premium tax credits.

In 2021, Democrats in Congress expanded the eligibility pool for enhanced premium tax credits - which are paid directly to insurers to subsidize premium costs - and set sliding scale caps for how much income individuals could pay toward their health insurance. But those credits are set to expire at the end of 2025, meaning that many ACA enrollees will be required to pay for a larger share of their premium.

Currently, enrollees between 100% and 150% of the federal poverty limit are eligible for free plans; but if the credits expire, they will need to pay between 2.1% and 4.19% of their premium cost, depending on their income. The higher an individual's income, the larger a portion of the premium cost they will need to pay.

Nationally, KFF estimated that ACA customers' average premium payments will more than double, increasing by 114% when tax credits are included.

Insurers cited the reversion of the looming tax credits as a reason for hiking rates in their initial filings over the summer. With open enrollment beginning Nov. 1, Congress has yet to act. Democrats refused to vote for a Republican-backed bill to temporarily fund the government unless Republicans, who control majorities in both chambers, addressed the expiring credits; thus far, the shutdown has gone on for 31 days with both parties at an impasse.

ACA enrollees can select plans of different metal tiers, which each have different levels of coverage, premiums and out-of-pocket costs.

KFF found that average Texas premiums are rising this year across all metal tiers. Between 2025 and 2026, the lowest-cost bronze plan premium is rising by 19.7%, silver by 35.1% and gold by 31.9%.

Individual premium costs are influenced by a number of factors, including the insurer, plan type, enrollee age and region. The size of the premium tax credit is then determined by expected income.

Texas is expected to be disproportionately affected by the expiration of the tax credits because it has more ACA enrollees - nearly 4 million - than every state but Florida. As one of 10 states that never expanded Medicaid to people earning over 100% of the federal poverty limit, the ACA has been a significant driver of coverage gains among lower-income Texans. Nearly two-thirds of Texans who get coverage through the ACA earn under 150% of the federal poverty limit - $23,475 for an individual or $48,225 for a family of four.

But without the enhanced tax credits, lower-income Texans used to paying no premium may end up changing metal tiers or dropping coverage once they see the cost of their 2026 plan. The expiration of the tax credits would also restore a 400% federal poverty level income cliff for subsidy eligibility, meaning the over 126,000 Texans in that income bracket who get ACA coverage will see major premium hikes.

Estimates vary among health policy organizations, but hundreds of thousands, if not well over a million Texans are expected to drop their health insurance coverage due to the ACA premium price increases. KFF has a calculator for ACA enrollees to learn how much their premium payments would rise, and Texans can shop for plans at Healthcare.gov.

This article first appeared on The Texas Tribune.