What’s Driving 2026 ACA Premium Increases?

Understanding Why Health Insurance Costs Are Rising Next Year

Each year, health insurers submit rate filings to state regulators outlining their expected costs and premium changes for Affordable Care Act (ACA) health plans. These filings give us a glimpse into what’s shaping next year’s premiums — and for 2026, there’s a lot happening.

Premiums Are Climbing Higher Than Usual

Across 312 ACA Marketplace insurers nationwide, the median proposed premium increase for 2026 is about 18% — nearly three times higher than last year’s 7% increase. In fact, this marks the largest proposed rate jump since 2018, when policy uncertainty last drove a sharp rise in premiums.

While some insurers are proposing smaller adjustments (as low as -10%), others are seeking increases of up to 59%, with most falling between 12% and 27%. These numbers are preliminary and may still change before rates are finalized later this year, but the message is clear — premiums are headed upward.

What’s Behind These Premium Increases?

After reviewing insurer filings from 19 states and Washington, D.C., a few consistent themes stand out as key cost drivers for 2026:

1. Rising Healthcare Costs

Health care services continue to grow more expensive — from hospital visits to routine care. Insurers are projecting medical cost trends around 8–10%, similar to last year, driven by both higher prices and greater use of care.

2. Inflation and Labor Costs

Inflation is adding pressure to the healthcare system. Hospitals and clinics are paying more for labor and supplies, and those higher costs trickle down to insurance premiums. Many insurers report that staffing shortages and wage increases have pushed providers to seek higher reimbursements.

3. Specialty Medications and GLP-1 Drugs

Prescription costs continue to soar — especially for GLP-1 medications like Ozempic and Wegovy, used for diabetes and weight loss. Utilization of these drugs is climbing fast, and insurers are struggling to balance affordability with coverage demands. Some insurers, such as Blue Cross Blue Shield of Massachusetts, are even removing coverage for GLP-1 drugs used for weight loss to help control rising costs.

4. Potential Policy Shifts

Several policy factors are adding uncertainty:

• Enhanced premium tax credits (expanded during the pandemic) are set to expire at the end of 2025 unless extended by Congress.

  • If they expire, average out-of-pocket costs for marketplace enrollees could rise over 75%, prompting healthier members to drop coverage — which in turn raises premiums further.

• New federal rules under the “Marketplace Integrity and Affordability” regulation may slightly affect enrollment patterns, depending on how they’re implemented.

• Tariffs on imported medical goods could also increase costs, though most insurers are taking a “wait and see” approach.

How This Affects Consumers

Most people who buy coverage through the Marketplace receive premium tax credits — about 92% in 2025 — so they may not feel the full impact of these increases. However, if the enhanced subsidies expire, many could see a dramatic jump in their monthly payments in 2026.

Even with subsidies in place, higher premiums typically mean higher federal spending on subsidies and more volatility in the market. The final 2026 rates will be confirmed later this year.

Key Takeaways for Agents and Clients

• Premiums are expected to rise significantly — around 18% on average for 2026.

• Rising healthcare and drug costs remain the biggest drivers.

• Policy uncertainty surrounding tax credits could amplify market changes.

• Advisors should help clients review their options carefully this fall to ensure they’re maximizing available subsidies and staying protected.

At Couvillier Advisors, we’re keeping a close eye on these changes to help our clients and agents prepare for 2026 Open Enrollment. As always, our goal is to make navigating health coverage easier — no matter how complex the landscape becomes.