People who get health insurance through the Affordable Care Act could soon see their monthly premiums sharply increase as subsidies expire and insurers propose a major premium hike for 2026.
Insurers that offer plans through the ACA are planning an average premium increase of 15% for 2026 — the largest increase in seven years, according to an analysis published Friday from KFF, a health policy research group. The analysis is based on filings from more than 100 insurers in 19 states and Washington, D.C.
The increase will likely come on top of the loss of enhanced subsidies that helped people pay for ACA health plans by capping the costs at a certain proportion of their income.
The finalized plans — including how much more people will be expected to pay each month — are usually published around August.
The enhanced subsidies came out of the 2021 American Rescue Plan and broadened the number of people eligible, including many in the middle class. The Inflation Reduction Act, passed in 2022, extended the subsidies through 2025.
The domestic policy bill that President Donald Trump signed into law earlier this month, however, did not extend them further. (Subsidies for people with very low incomes that were put in place when the ACA was enacted will still be available.) The bill also added more hurdles for people who get their health insurance through the ACA, such as adding new paperwork requirements to renew coverage each year.
Nearly 4 million people were projected to lose their coverage next year if the subsidies weren’t extended, according to a 2024 analysis from the Congressional Budget Office, a nonpartisan agency that provides budget and economic information to Congress.
A loss of coverage would also have implications for the cost of insurance.
With fewer people enrolled, insurers would have to spread the costs among a smaller group of people, pushing premiums higher, said Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy.
An earlier analysis from KFF, published this month, found that more than 22 million people could see a sharp premium increase starting Jan. 1.
“This is not a repeal [of the ACA], but it’s certainly an attempt to move in that direction,” Park said. “It’ll be much more costly, so that means it’ll be less affordable for you to purchase a plan or renew your coverage.”
Chris Meekins, a health policy research analyst at the investment firm Raymond James who served in the first Trump administration, said the chances that Congress will extend the subsidies in time for next year are slim, as Trump and other Republicans have signaled that they don’t support them.
Higher out-of-pocket costs
ACA enrollment reached a record high last year, totaling more than 24 million people, according to the Centers for Medicare & Medicaid Services. Much of that growth was from the extended subsidies, the agency said. The average monthly premium was $113, compared with $162 in 2020.
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According to KFF’s latest analysis, most ACA insurers are proposing premium increases of 10% to 20% for 2026. More than a quarter, the group said, are proposing premium increases of 20% or more.
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What people actually end up paying out of pocket for their monthly premiums could increase, on average, by more than 75%, Larry Levitt, the executive vice president for health policy at KFF, said on a call with reporters last week.
A family of three earning $110,000 a year and enrolled in a silver ACA plan — which usually comes with moderate monthly premiums — could see their monthly cost jump from $779 this year to $1,446 in 2026 when the enhanced subsidies expire, according to KFF. If insurers raise premiums by 15%, the monthly bill could climb even higher, to $1,662.
Some people may be able to keep their coverage by paying more in premiums each month or dropping down to so-called high-deductible plans, which have lower monthly premiums but require people to pay more out of pocket before coverage kicks in, Cynthia Cox, director of the program on the ACA, said on the same call.
Along with the other changes in the domestic policy bill, “it amounts to what is effectively a partial repeal of the ACA, erasing a lot of its gain in health coverage,” Levitt said.
The subsidies on track to expire, however, aren’t the only factor insurers are taking into account in their premium proposals, KFF’s analysis found.
They’re also concerned about the potential impact of tariffs on some drugs, medical equipment and supplies.
Earlier this month, Trump threatened to impose up to 200% tariffs “very soon” on pharmaceuticals imported into the U.S. The majority of prescription drugs that people take in the U.S. are manufactured overseas.
Insurers also cited the anticipated growth in the cost of health care services, according to KFF. They also mentioned the cost of GLP-1 drugs, a class of medications that include the blockbuster drugs Ozempic and Wegovy. The drugs can cost more than $1,000 for a monthly supply.
On Thursday, a group of Democratic attorneys general filed a lawsuit to block a separate rule by the Trump administration that also makes changes to the ACA.
