Health insurers on the Affordable Care Act (ACA) marketplaces are gearing up for the largest premium increases in nearly a decade. Proposed hikes for the 2026 plan year could reach record levels, with some insurers suggesting double-digit increases that are making headlines across the country.
If you’re enrolled in an ACA plan or considering coverage during the next open enrollment, it’s important to understand what’s driving these increases—and what it could mean for your health insurance costs.
Why Are ACA Premiums Rising So Much?
Insurers are seeking a typical rate increase of 15%, and over 25% of providers are proposing hikes of 20% or more. These jumps mark the steepest average increases since 2018.
What’s Driving the Increases?
The upward pressure on premiums is a result of several key factors:
-
Rising medical and prescription costs
-
Expiration of enhanced federal subsidies, making coverage less affordable for many
-
Projected costs from new pharmaceutical tariffs
-
Uncertainty from recent healthcare policy changes, including reduced access to special enrollment
Let’s take a closer look at each of these.
1. Rising Healthcare Costs
As usual, increasing costs in medical care, hospital services, and prescriptions remain the baseline drivers for premium hikes. These industry-wide cost increases typically fuel the majority of year-over-year price changes.
2. Expiration of Enhanced ACA Premium Subsidies
The enhanced ACA subsidies, introduced in 2021, made insurance significantly more affordable. These subsidies allowed many lower- and middle-income Americans to enroll in ACA coverage for less than $10 a month, or in some cases, at no monthly premium at all.
These additional subsidies are set to end this year. Without them, insurers expect many cost-conscious and healthy enrollees to exit the ACA marketplace, leaving a higher-risk pool behind. Insurers estimate this impact alone could add an average of 4% or more to 2026 premiums beyond baseline medical inflation.
3. Trump-Era Policies and New Tariffs
The return of Trump administration healthcare policies, including proposed tariffs on pharmaceutical imports, is adding another layer of uncertainty. Some insurers say these tariffs could increase operational costs, which they plan to offset with extra premium increases—estimated at around 3% in some filings.
4. Recent Regulatory Changes
New federal guidelines will:
-
Shorten the ACA open enrollment window
-
Increase identity and income verification
-
Limit low-income, year-round enrollment access
These changes may discourage consistent enrollment, worsen risk pools, and create premium volatility depending on each state’s response.
State and Market-Level Responses
Maryland Example
In Maryland, insurance carriers have proposed a 17.1% overall average premium increase, the highest since 2019. State officials noted that if enhanced subsidies were extended, the hike would be cut nearly in half—landing closer to 7.9%.
Some states are now considering state-level subsidy programs to cushion consumers from these federal rollbacks.
Market Uncertainty and Insurer Withdrawals
Several insurers have raised concerns about the unpredictability of the policy environment moving forward. A major provider, Aetna, has already announced plans to exit the ACA individual market in 2026, citing difficulties in maintaining the same value and affordability offered in past years. Aetna previously exited the market in 2018 before briefly returning.
What It Means for Consumers
These proposed increases come at a critical time. Open enrollment begins November 1, and premiums could climb dramatically for the 24+ million Americans currently enrolled in Affordable Care Act plans.
Tips for ACA Plan Members:
-
Stay updated: Final approved rates will be released later this summer. Revisit your online exchange or insurer in advance.
-
Compare plans carefully: Use online tools to explore other plan options. Premiums can vary significantly by tier and region.
-
Monitor state-level announcements: Your state may introduce local subsidies or outreach efforts to reduce your cost burden.
-
Check for employer alternatives: If ACA plan costs are too high, it’s worth checking local job boards or freelancers’ networks for opportunities that might include health benefits.
What Comes Next?
Most of these rate hikes are preliminary and could change depending on:
-
Further government action at the state or federal level
-
Final decisions by regulators in states with independent ACA marketplaces
-
Enrollment trends during the upcoming sign-up period
For now, premiums are expected to rise significantly—especially for those losing access to enhanced federal subsidies.
Final Thoughts
ACA insurers’ proposed premium increases for 2026 reflect a mix of economic pressure, regulatory shifts, and political uncertainty. Without further intervention, millions of Americans could face higher monthly bills—or be forced to reconsider their coverage entirely.
The coming months will reveal whether state and federal lawmakers take steps to soften the impact. In the meantime, consumers are encouraged to stay informed, compare plan options, and prepare for possible household budget changes related to healthcare.