Increasing 2026 ACA Market Place Premiums

“How much and why ACA Marketplace Premiums are going up in 2026?”

Peterson-KFF Health System Tracker

Health insurers submit rate filings annually to state regulators detailing expectations and rate changes for Affordable Care Act (ACA)-regulated health plans for the coming year. A relatively small, but growing, share of the population is enrolled in these plans (compared to the number in employer plans), fueled by the availability of enhanced premium tax credits. The analysis focuses on individual market filings, which are generally more detailed and publicly available. These filings provide insight into what factors insurers expect will drive health costs for the coming year.

For 2026, across 312 insurers are participating in the ACA Marketplaces from the 50 states and the District of Columbia. This analysis shows a median proposed premium increase of 18%, which is about 11 percentage points higher than last year. The projected increase is the largest rate change insurers have requested since 2018. Then, policy uncertainty contributed to sharp premium increases.

On average, ACA Marketplace insurers are raising premiums by about 20% in 2026. This is based on a more detailed analysis of available documents from insurers in 19 states and the District of Columbia. As in prior years, the growth in health care prices stood out as a key factor driving costs in 2026. Insurers cite increasing cost and utilization of high-priced drugs as well as general market factors such as labor costs and inflation.

There are rising healthcare costs to be considered. Also being considered by the majority of insurers is the potential expiration of enhanced premium tax credits which adds to their premium rate increases for the next year. The expiration of enhanced tax credits will lead to out-of-pocket premiums for ACA marketplace enrollees. Plan on an increase of an average of >than 75%. Insurers expect healthier enrollees to drop coverage. The decrease in turn, increases underlying premiums. Other federal policy changes? The implementation of tariffs (think Tru_p) and the ACA Marketplace Integrity and Affordability rule were also discussed, though to a lesser extent.

ACA Marketplace insurers are proposing a median premium increase of about 18% in 2026

Among the 312 ACA Marketplace participating insurers nationally, premium changes range from -10% to 59%. The most proposed premium changes for 2026 fall between about 12% and 27% (the 25th and 75th percentile, respectively). Of the 312 insurer filings, 4 insurers proposed decreasing premiums. At the other end of the spectrum, 125 insurers requested premium increases of at least 20%. The filings are preliminary and may change during the rate review process. The 2026 rates will be finalized in late summer. Proposed premium increases by state and insurer are in the Appendix. Included below and to the right is the first page of the appendix.

There are a number of ways to assess premium changes in this market. In this analysis, a premium increase for a given insurer is its enrollment-weighted average of rate changes across all of its products within a state (i.e., bronze, silver, gold and platinum plans). These weighted average premium changes differ from the percent change in the benchmark silver plan, which is the basis for federal subsidies.

In 2025, the median proposed rate increase was 7%, while the average increase in benchmark silver premiums was 4% in 2025.  The vast majority of ACA Marketplace enrollees (92% in 2025) receive a subsidy and may not expect to face these premium increases depending on the plan they select. A potential expiration of the enhanced premium tax credits would decrease financial assistance across the board for all subsidized enrollees. Such would lead to a >than 75% increase in average out-of-pocket premium payments. All else equal, premium increases generally result in higher federal spending on subsidies.

What is driving 2026 premium changes?

Figure 1 above shows premium changes for 312 insurers across all 50 states and DC. For the subsequent sections, this analysis focuses on a subset of rate filings (105 insurers across 19 states and the District of Columbia), reviewed in more detail to better understand the factors driving premium changes in 2026. Across the 19 states and DC reviewed in this section, insurers have somewhat lower proposed rate increases, with a median of 15%.

Rising healthcare costs

In most years, rising healthcare costs consisting of the price of care and increasing usage – are driving increasing rates. The costs of health care services like hospitalizations and physician care, as well as prescription drug costs tend to go up every year. Insurers often raise premiums to cover their increased costs. For 2026, insurers commonly say the underlying cost of health care (medical trend) is similar to last year’s reported 8%.

The increasing cost of medical care is a significant driver of the rate change. This filing reflects the projected claims expenses increasing approximately 10% annually. About 7% of this increase is due to cost and utilization changes.” – Regence BlueCross Blue Shield of Oregon (Washington)

“The underlying claim costs are expected to increase from 2024 to 2026, which is reflective of anticipated changes in the prices of medical services, the frequency with which consumers utilize services, as well as any changes in network contracts or provider payment mechanisms.” – Cigna HealthCare of Georgia, Inc. (Georgia).

Inflation

A small number of insurers have also cited general economic inflation as a driver of higher administrative and internal operating expenses. This inflationary environment places healthcare systems and providers under increasing financial strain, which contributes to increases in premiums.

“Blue Cross VT base administrative charges are increasing as compared to the 2025 approved rates, mostly due to inflationary pressures (see section 3.8.7), increasing premiums by 0.2 percent for individuals and 0.4 percent for small groups.” – Blue Cross Blue Shield of Vermont (Vermont)

Labor costs, contracting, and provider consolidation

A number of insurers also cite healthcare labor costs as driven by persistent clinical workforce shortages and broader inflation. Both can be(?) a meaningful contributor to rising healthcare costs and 2026 premium increases. Providers are seeking higher reimbursement rates in negotiations, citing elevated staffing costs and continued post-pandemic financial difficulties, which insurers incorporate into their trend assumptions.

“Like other payers, Moda is experiencing pressures on multiple fronts related to health care worker labor shortages. With providers experiencing post-pandemic inflationary pressures, they are seeking increases that generally exceed previous years’ requests.” – Moda Health Plan (Oregon)

“Physicians and hospitals are facing economic pressures caused by supply chain shortages, overall inflation and continued workforce challenges. As a result, providers are seeking higher reimbursement for their services.” – Health New England, Inc. (Massachusetts).

Health insurers submit rate filings annually to state regulators detailing expectations and rate changes for Affordable Care Act (ACA)-regulated health plans for the coming year. A relatively small, but growing, share of the population is enrolled in these plans (compared to the number in employer plans), fueled by the availability of enhanced premium tax credits. This analysis focuses on individual market filings, which are generally more detailed and publicly available. These filings provide insight into what factors insurers expect will drive health costs for the coming year.

For 2026, across 312 insurers participating in the ACA Marketplaces from the 50 states and the District of Columbia, this analysis shows a median proposed premium increase of 18%, which is about 11 percentage points higher than last year. This is the largest rate change insurers have requested since 2018, the last time that policy uncertainty contributed to sharp premium increases. On average, ACA Marketplace insurers are raising premiums by about 20% in 2026. Based on a more detailed analysis of available documents from insurers in 19 states and the District of Columbia, like in prior years, growth in health care prices stood out as a key factor driving costs in 2026. Insurers cite increasing cost and utilization of high-priced drugs as well as general market factors, such as increasing labor costs and inflation, as contributing to premium increases.

In addition to rising healthcare costs, the majority of insurers are also taking into account the potential expiration of enhanced premium tax credits in their premium rate increases for the next year. The expiration of enhanced tax credits will lead to out-of-pocket premiums for ACA marketplace enrollees increasing by an average of more than 75%, with insurers expecting healthier enrollees to drop coverage. That, in turn, increases underlying premiums. Other federal policy changes, like the implementation of tariffs and the ACA Marketplace Integrity and Affordability rule were also discussed, though to a lesser extent.

Trend

As in in most years, rising healthcare costs – both the price of care and increased use – are driving increasing rates. The costs of health care services like hospitalizations and physician care, as well as prescription drug costs tend to go up every year, and insurers often raise premiums to cover their increased costs. For 2026, insurers commonly say the underlying cost of health care (medical trend) is similar to last year’s reported 8%.

“The increasing cost of medical care is a significant driver of the rate change. This filing reflects the projected claims expenses increasing approximately 10% annually. About 7% of this increase is due to cost and utilization changes.” – Regence BlueCross Blue Shield of Oregon (Washington)

“The underlying claim costs are expected to increase from 2024 to 2026, which is reflective of anticipated changes in the prices of medical services, the frequency with which consumers utilize services, as well as any changes in network contracts or provider payment mechanisms.” – Cigna HealthCare of Georgia, Inc. (Georgia)

Inflation

A small number of insurers have also cited general economic inflation as a driver of higher administrative and internal operating expenses. This inflationary environment places healthcare systems and providers under increasing financial strain, which contributes to increases in premiums.

“Blue Cross VT base administrative charges are increasing as compared to the 2025 approved rates, mostly due to inflationary pressures (see section 3.8.7), increasing premiums by 0.2 percent for individuals and 0.4 percent for small groups.” – Blue Cross Blue Shield of Vermont (Vermont)

Labor costs, contracting, and provider consolidation

A number of insurers also cite healthcare labor costs – driven by persistent clinical workforce shortages and broader inflation – as a meaningful contributor to rising healthcare costs and 2026 premium increases. Providers are seeking higher reimbursement rates in negotiations, citing elevated staffing costs and continued post-pandemic financial difficulties, which insurers incorporate into their trend assumptions.

“Like other payers, Moda is experiencing pressures on multiple fronts related to health care worker labor shortages. With providers experiencing post-pandemic inflationary pressures, they are seeking increases that generally exceed previous years’ requests.” – Moda Health Plan (Oregon)

“Physicians and hospitals are facing economic pressures caused by supply chain shortages, overall inflation and continued workforce challenges. As a result, providers are seeking higher reimbursement for their services.” – Health New England, Inc. (Massachusetts)

In a handful of filings, insurers also point to provider consolidation. Hospital mergers and acquisitions contributing to higher contracted prices for services and reduced innovation due to increased provider market power.

“Many systems are asking for large increases for services (requesting and receiving double-digit annual increases). They have shown a willingness to allow our contracts to expire. Because of the limited competition and regional monopolies health care providers have achieved, reduced market pressure exists for systems to innovate new, more efficient practices.” – LifeWise Health Plan of Washington (Washington)

GLP-1s and specialty medications

Growing demand for GLP-1 drugs such as Ozempic and Wegovy contribute to increased prescription drug spending. ACA Marketplace insurers frequently apply utilization management policies like prior authorization and quantity limits to manage the high costs of GLP-1 drugs. GLP drugs are used for diabetes treatment and weight loss. Several insurers point to continued high utilization of GLP-1s (gained popularity in recent years) as a driver of increased trend and premiums.

Other Factors?

Trump Tariffs, Federal Policy Charges such as Expiration of enhanced premium tax credits, 2025 Market place Integrity and Affordability Rule, Republican budget reconciliation package, No Surprises Act, Price transparency, etc.