Health insurers plan to raise Affordable Care Act (ACA) Marketplace premiums by an average of 26% in 2026, the steepest increase since the marketplaces launched.
If Congress allows enhanced premium tax credits to expire at the end of 2025, consumer payments could more than double, rising about 114% on average.
The surge is driven by higher hospital costs, costly new drugs, and policy uncertainty over the future of federal subsidies.
Premiums for health plans sold on the Affordable Care Act (ACA) Marketplaces are expected to surge an average of 26% in 2026, according to a new analysis by KFF. The spike reflects what insurers are charging before tax credits are applied — a sharp acceleration compared to prior years.
The increase will not hit all consumers equally. In states running their own Marketplaces, the average benchmark silver plan premium — used to calculate federal tax credits — is set to rise 17%. In the 32 states using Healthcare.gov, premiums will climb even higher, by about 30%.
Currently, about 22 million of the 24 million Marketplace enrollees receive federal premium tax credits that cap what they pay based on income. These enhanced subsidies, expanded under the American Rescue Plan and extended by the Inflation Reduction Act, ensure that most low- and middle-income consumers pay a fixed share of their earnings, not the full price set by insurers.
If Congress extends these enhanced tax credits, the out-of-pocket cost for most enrollees will remain stable despite rising insurer charges. But if lawmakers allow the expanded aid to expire at the end of this year, average consumer payments would more than double, according to KFF estimates.
Without the enhanced subsidies, enrollees with incomes below four times the federal poverty line would receive less assistance, while those above that threshold would lose eligibility altogether — leaving many to face a “double hit” of higher premiums and reduced aid.
Shifting plans and rising deductibles
Even if subsidies lapse, some lower-income consumers could still find bronze-tier plans with little or no premium after smaller tax credits are applied. However, those plans come with a steep tradeoff: deductibles exceeding $7,000, compared with reduced deductibles below $100 for silver-tier plans that include cost-sharing reductions.
The likely result, experts say, is a migration from silver to bronze coverage — reducing financial protection for millions of enrollees.
What’s driving the surge
Insurers cite several forces behind the 2026 premium hikes. The biggest culprits include:
Rising hospital and medical costs
The growing use of expensive GLP-1 weight-loss drugs such as Ozempic
Broader inflation and potential tariffs increasing healthcare supply costs
In addition, insurers say they are adding roughly four percentage points to their requested increases because they expect healthier enrollees to drop coverage if subsidies lapse — leaving a sicker, costlier risk pool behind.
Because the ACA’s tax credits are pegged to the second-lowest-cost silver plan, higher benchmark premiums automatically drive up the federal government’s subsidy spending. Even as insurers raise rates, taxpayers may bear more of the cost — especially if Congress renews the enhanced credits.
Whether lawmakers extend those subsidies or let them expire could determine whether 2026 brings a financial shock for millions of Americans — or another year of stability in the ACA marketplaces.