Health insurance premiums on the Affordable Care Act (ACA) Marketplace are poised for their most significant increase since 2018, with insurers proposing a median rate hike of 15% for 2026. This surge is driven by a combination of rising healthcare costs and major policy changes, marking a sharp departure from the modest premium growth of recent years.
The analysis, based on preliminary rate filings from 105 insurers across 19 states and the District of Columbia, shows that the underlying growth in medical costs remains a primary driver. Insurers estimate this “medical trend”—reflecting the rising price and use of healthcare services—at approximately 8% for 2026, consistent with the previous year. Key factors cited include higher costs for hospital and physician care, labor market pressures on provider contracts, and increased spending on prescription drugs, such as GLP-1 medications.
A significant new factor for 2026 is the scheduled expiration of enhanced premium tax credits at the end of 2025. These subsidies have substantially lowered out-of-pocket costs for millions. Insurers predict their expiration will cause healthier individuals to drop coverage, leading to a sicker, more expensive risk pool. To compensate, most are adding an extra 4% to their proposed rate increases. Without congressional action, subsidized enrollees could see their direct premium payments rise by an average of more than 75%.
Insurers also point to potential tariffs on imported pharmaceuticals and medical supplies as a source of cost pressure. The companies that have quantified this impact are adding approximately 3% to their rates to account for the uncertainty.
The scale of the proposed 2026 increases is notable. More than a quarter (27%) of the analyzed insurers are requesting hikes of 20% or more, a stark contrast to 2025 when only 3% did so. For the first time in several years, no insurers have proposed rate decreases. For comparison, the median proposed increase for 2025 was 7%.
These preliminary rates are still under review by state regulators and may be adjusted. Finalized 2026 premiums are expected to be published in late summer, ahead of the open enrollment period that begins November 1.
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