📝 usncan Note: People Buying ACA Health Insurance Brace For Hefty Premium Increases
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Affordable Care Act (Obamacare) premiums are due to significantly rise in 2026.
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We’re coming up on open enrollment season for health insurance. Notices will be sent out soon, online or by regular mail, containing options individuals and families can choose from and their corresponding monthly premiums as well as out-of-pocket patient cost-sharing amounts. Across the commercial and Medicare markets, health insurance premiums will rise. But there will likely be particular sticker shock in the Affordable Care Act markets.
Recently released KFF data shows that ACA insurers are seeking a median 18% premium hike for 2026—the biggest since 2018 and well above last year’s 7% figure. Some states are reporting much higher proposed increases. Premiums may also skyrocket in the individual market for those who don’t qualify for ACA subsidies.
Rising healthcare costs are partly to blame. The prices of medical care services and technologies along with increased utilization are cited as drivers behind premium spikes. Healthcare cost increases are projected to be 8% in 2026, which is about the same as in 2025 and well above the consumer price index or general inflation.
President Trump signed the “Big Beautiful Bill” into law in July. Nearly 12 million Americans could lose their health insurance coverage by 2034 due to this legislation, according to the nonpartisan Congressional Budget Office. This is due mostly to people being disenrolled from Medicaid. However, other projections suggest the number could be even higher, totaling more than 17 million. The greater number accounts for at least five million Americans who currently have ACA health insurance losing their coverage once subsidies expire at the end of this year.
The legislation codifies a rule the Trump administration issued in the spring that allows ACA subsidies to expire and this in turn will probably lead to sharply lower enrollment. The rule also imposes new verification requirements, adds an automatic monthly charge on all automatically reenrolled consumers who qualify for $0 premiums, shortens the open enrollment period for people who wish to sign up for health coverage and increases the costs incurred by states in providing healthcare, including higher state expenditures on Medicaid, uncompensated emergency care and other services for newly uninsured residents.
The United States District Court of Maryland granted a preliminary injunction at the end of August, blocking implementation of the Trump administration’s new rule projected to strip health coverage from millions of people and undermine certain ACA core protections. These include limits on patient out-of-pocket cost sharing. Looming cuts to ACA subsidies coupled with the lifting of certain regulations could leave millions with unaffordable plans
It’s unclear how the BBB’s codification of the rule could affect the status of the injunction as it proceeds through the courts.
As Elisabeth Rosenthal of KFF Health News points out, while this year’s increases will be large, the health insurance market has seen massive rises in premiums for the past 25 years. Family health insurance premiums have surged 297% since 2000. Workers have paid nearly four times more for the same coverage in employer-based plans as in 2000, far exceeding the general inflation rate.
High-deductible health plans have also become more common, with 32% of workers facing deductibles of $2,000 or more. And deductibles for employer-based plans have risen nearly 50% since 2015. This is money insured enrollees must spend out-of-pocket before insurance kicks in.
Even without accounting for changes due to go into effect as a result of the BBB, the situation in parts of the ACA marketplace has become worse. An average deductible for a standard ACA silver plan in 2025 is nearly $5,000, approximately twice what it was a decade ago. This is likely to go up further in 2026.
And with tax credits that many Americans rely on to keep their premiums affordable due to expire, affordability of care will be at stake. Subsidized ACA enrollees have been mostly insulated from premium increases because such credits tie costs to their income. During the COVID-19 pandemic, the federal government created more generous tax credits for the ACA exchanges, which reached people earning up to around $60,000 a year. Without these enhanced subsidies on the exchanges, the CBO expects costs to rise by a whopping 75% for most people and 90% for those in rural areas. While Congress could pass a bill extending the subsidies before the end of the year, this is far from certain.
Insurers expect healthier enrollees to drop coverage. This leaves the remainder, folks more likely to purchase insurance because of poorer health, with potentially exorbitant premiums and out-of-pocket costs.
