ACA Premiums Set to Spike Significantly in 2026, Raising Concerns for Enrollees
By Nathaniel Weixel, Joseph Choi, and Alejandra O’Connell-Domenech
Published August 6, 2025 – 7:39 PM ET
Health insurance premiums for individuals purchasing coverage through the Affordable Care Act (ACA) marketplaces are projected to surge dramatically in 2026. According to a recent analysis of preliminary filings by the Kaiser Family Foundation (KFF), the median proposed premium increase nationwide stands at 18 percent—more than double last year’s 7 percent increase. This marks the steepest requested rate hike by insurers since 2018, a year characterized by policy uncertainty that drove major premium spikes.
Scope of Proposed Premium Increases
The analysis encompasses proposed premium changes from 312 insurers across all 50 states and the District of Columbia. On average, insurers are seeking approximately 20 percent hikes for plans sold via the ACA marketplaces. While these rates remain preliminary and could be adjusted before official approval later this summer, the increases signal a significant rise in consumers’ health insurance costs.
Drivers Behind Higher Premiums
Insurers attribute the need for higher premiums primarily to escalating healthcare expenses. Rising costs for hospital services, physician care, and prescription medications are cited as major factors. Although tariffs on imported goods have the potential to contribute to increasing medical expenses, insurers have expressed uncertainty regarding the impact of such tariffs and have not widely listed them as a direct cause for the premium increases.
In addition, insurers are factoring in possible changes to federal subsidies. Enhanced premium tax credits, originally instituted during the COVID-19 pandemic to help consumers afford coverage, are set to expire at the end of the year. Many insurers anticipate the absence of these subsidies in 2026 and have adjusted their rate proposals accordingly.
Implications for Subsidized Enrollees
If Congress fails to act to extend or replace the enhanced premium tax credits, enrollees who rely on subsidies could face premium increases exceeding 75 percent beginning January 2026, KFF warns. This potential outcome has raised alarms among consumer advocates and policymakers concerned about affordability and access to coverage.
State Responses and Pushback
Some states are already pushing back against what they consider excessive rate hikes. For example, Arkansas Governor Sarah Huckabee Sanders publicly urged the state’s insurance commissioner to reject proposed premium increases submitted by major insurers Centene and Blue Cross Blue Shield, which reached up to 54 percent and 25.5 percent respectively. Governor Huckabee Sanders emphasized the commissioner’s duty to disapprove rates deemed “excessive or discriminatory” to protect consumers.
Looking Ahead
As insurers finalize their rate requests and state regulators review them over the coming weeks, consumers and policymakers will closely watch for developments that could influence the final cost of ACA marketplace coverage. The potential expiration of enhanced subsidies remains a critical factor that could substantially affect affordability for millions of Americans.
The Smart Money Mindset team will continue to monitor these unfolding changes and provide updates on how they may impact your healthcare expenses in the coming year.
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