ACA Marketplace Premiums Projected to Jump in 2026

If you buy health insurance through the Affordable Care Act (ACA) marketplace, you will want to pay attention to this information. Premiums could rise sharply in 2026, according to a new analysis by the Peterson Center on Healthcare and the Kaiser Family Foundation. Based on preliminary filings from more than 300 insurers across the U.S., the average proposed increase is about 18%, with some states seeing even higher hikes.

If those projections hold, it would be the largest increase since 2018, when policy uncertainty also sent rates soaring. So what’s behind these changes—and what can you do about it?

Let’s break it down.

What’s Driving the Premium Increases?

There’s no single reason for the higher costs—multiple forces are converging. Here are the key factors insurers are citing:

Expiration of Enhanced Subsidies

One of the biggest drivers is the scheduled end of expanded premium tax credits (first introduced in 2021 during the pandemic).
These enhanced subsidies have helped millions of lower-income Americans pay little or nothing for their monthly premiums.
Without congressional action to extend them, premiums could rise more than 75% for subsidized enrollees in 2026.
In at least 12 states, out-of-pocket premiums may double for some enrollees.

When subsidies shrink, many healthier individuals may opt out of coverage—leaving a pool of higher-risk, higher-cost enrollees. That shift could trigger even more premium hikes in future years.

Other Cost Pressures

Insurers also point to rising healthcare costs and systemic issues:

Medical cost inflation: Hospital stays, doctor visits, and outpatient services are rising 8–10% per year in many areas.
Expensive new drugs: Use of GLP-1 medications like Ozempic and Wegovy—and high-tech treatments like gene therapies—has driven up pharmacy costs.
Labor shortages: Healthcare facilities continue to pay more for staff, and those costs are reflected in insurance premiums.
General inflation: Broader economic inflation affects everything from administrative expenses to medical supply prices.
Trade uncertainty: Some insurers are preparing for potential tariffs on medications and medical products, which could push costs even higher.

What This Could Mean for You

If you get your health insurance through the ACA marketplace, 2026 will likely bring higher premiums, especially if the enhanced subsidies expire. Here’s how you can prepare:

Be proactive during open enrollment

Compare plans carefully. Shopping around is more important than ever—premiums can vary widely between insurers and plan types.
Switching metal tiers (for example, from Gold to Silver or Bronze) may help reduce your premium, depending on your healthcare needs.

Make sure your income estimate is accurate

Your premium tax credit is based on your reported income. An accurate estimate ensures you get the right subsidy—and avoids surprises when you file your taxes.
If your income changes during the year, update it in your marketplace profile as soon as possible.

Plan for different subsidy scenarios

It's still uncertain whether premium subsidies will be extended beyond 2025.
We can help you model your 2026 premium under both scenarios—with and without the enhanced credits—so you’ll know what to expect and can plan ahead.