A sharp rise in Marketplace insurance premiums is expected in 2026, risking higher costs for millions of Americans already grappling with healthcare affordability.

At a Glance

• Insurers are proposing an average increase of 15% in ACA exchange premiums for 2026, the highest jump since 2018.
• Over 25% of insurers are requesting premium hikes of 20% or more.
• Enhanced federal premium subsidies are set to expire December 31, 2025.
• Rising medical costs, labor shortages, and tariffs are driving additional inflation in health coverage.
• Middle-income Americans will be hit hardest by premium increases as subsidies disappear.

Why Premiums Are Jumping

The largest proposed rate increases in seven years are driven by the expiration of pandemic-era premium subsidies that made coverage more affordable. Without those subsidies, insurers expect many healthier individuals to leave the market, leading to a sicker and more expensive risk pool.

Medical inflation is another key factor. Insurers cite surging prices for breakthrough drugs, such as GLP-1 medications for diabetes and weight loss, as major cost drivers. Labor costs in the healthcare sector have also spiked, further pressuring insurers to raise premiums. Analysts estimate that these combined forces could push premiums up by $150 to $400 annually for many households.

Watch a report: Affordable Care Act: Insurers plan to hike monthly premiums by 2026 — YouTube

Who Will Be Most Affected

Without congressional action to extend subsidies, middle-income families earning just above the eligibility threshold will bear the brunt of the increase. In some states, such as Maryland, Washington, and Rhode Island, premiums could double for unsubsidized consumers.

Insurance providers like Blue Cross Blue Shield of Texas and Illinois have already filed requests for rate increases between 21% and 27%. This marks the steepest jump since 2018 and threatens to reduce enrollment as more Americans opt out of coverage due to cost.

Policy Backlash and Next Steps

The premium hikes are sparking political backlash. Democratic attorneys general from 20 states have launched legal challenges to block federal policy changes that would further restrict enrollment windows and increase costs. Meanwhile, health policy advocates are urging Congress to act swiftly to preserve or renew subsidies before open enrollment begins.

If no intervention occurs, millions of Americans will confront higher premiums and potentially reduced coverage options in 2026. The fallout could shape voter sentiment in the lead-up to the presidential election, turning healthcare costs into a defining political battleground.