What do insurer rate filings for 2026 show about anticipated premium increases and insurer market exits across states?
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Executive summary
Insurer rate filings for 2026 overwhelmingly point to steep, nationwide premium increases — typically double‑digit and in many analyses centering around the high teens to low twenties — and a risk of additional insurer market exits driven largely by federal policy uncertainty and changes to subsidies and enrollment rules [1] [2] [3]. Filings are preliminary and vary widely by state and carrier, with some analyses putting average requested increases as low as the low‑teens and others estimating much larger changes once insurer behavior and final approvals are counted [4] [5].
1. What the filings say about the size of premium increases
Across the published filings and early analyses, insurers are requesting substantially larger increases for 2026 than in recent years: one comprehensive review finds a median proposed increase of about 18% across all states (312 insurers) [1], another detailed sample puts average Marketplace increases near 20% [2], and KFF’s later accounting reports an even higher average of roughly 26% when aggregating approved and expected benchmark changes [5].
2. Variation by market and state — big swings, local extremes
The filings are not uniform: state‑level and plan‑level requests range from modest single‑digit changes to dramatic spikes — some data show insurer requests spanning roughly 0.9% up to 66.4% with weighted averages often above 13% in sampled states [4], while state trackers and aggregator sites list specific plans and states with increases in the 20–30% range or higher [6] [7]. Several states including Arkansas, Illinois, Indiana and Washington have finalized or approved increases exceeding 20% [8] [9].
3. Why insurers are asking for so much — medical costs and policy shock
Insurers flag familiar cost drivers — higher prices for care and utilization — plus newer inputs: expectations about costly medications (GLP‑1s), labor pressures in provider markets, and projected changes in the risk pool if subsidies lapse or administrative rules change [10] [2]. Analysts also note insurers explicitly built in higher rates because they anticipate healthier enrollees may leave if enhanced premium tax credits expire, which some filings quantify as adding several percentage points to rates [11] [4].
4. The role of federal policy uncertainty
A recurring theme in filings is federal policy uncertainty: insurers were often required to file under current law even while discussing likely future changes (H.R. 1, Marketplace Integrity rule, subsidy expirations), leading carriers to warn that their 2026 rates could be underestimates or subject to revision and to factor in enrollment and morbidity shifts tied to those policies [3] [2]. That policy noise amplifies both rate requests and strategic decisions about which markets to stay in.
5. Market exits: Aetna is the canary, more could follow
Filings and reporting document at least one major market exit already: Aetna announced it will leave ACA Marketplaces after 2025, affecting about 1 million consumers across 17 states — an explicit consequence insurers attribute in part to federal policy uncertainty [3]. Analysts warn other carriers may withdraw from some markets if the projected smaller, sicker enrollee pool materializes, though filings are preliminary and regulators still review final participation [3] [10].
6. How much of the pain will fall on consumers — subsidies and approvals matter
The ultimate consumer impact depends heavily on policy and regulator actions: federal premium tax credits currently cushion many enrollees (most marketplace enrollees qualify) and state‑level decisions or subsidy extensions could materially blunt out‑of‑pocket increases, while state insurance regulators retain authority to approve or modify requested rates [8] [9]. Analysts stress that preliminary filings are a snapshot, not a final bill, and approvals and subsidy policy will determine whether increases translate into unaffordable premiums for most people [1] [4].