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Fact check: Would the ACA increase by 18% without subsidies in 2026
Executive Summary
The available reporting and analyses show two related but distinct facts: insurers’ proposed or expected base premiums in the ACA individual market are rising by roughly the mid-20s percent in 2026, while the out‑of‑pocket costs for many enrollees would jump much more — in some analyses more than double — if the temporary enhanced premium tax credits expire. Specifically, analysts and news outlets report average increases of about 26% in what insurers charge and roughly 30% for benchmark plans on Healthcare.gov, while the loss of enhanced subsidies would produce average enrollee payment increases on the order of 100%+ (commonly cited ~114%), depending on methodology and population [1] [2] [3].
1. Why the “18%” figure keeps appearing — and what it actually refers to
Multiple briefings and trackers show a range of percentage changes that vary by metric and source; one prominent figure reported is a median insurer rate request of about 18%, which reflects proposed changes insurers submitted to regulators — not the final enrollee payment impact. That 18% number is portrayed as the largest insurer-requested change since 2018 and is driven by rising medical costs, inflation, and uncertainty about subsidy policy, but it is distinct from the marketplace-wide premium averages and from the ultimate amount consumers pay after tax credits are applied [2]. Media and analysts sometimes conflate insurer rate requests, average underlying premium growth, and consumer-facing premiums after subsidies, producing confusion; the 18% figure aligns with insurer filings but sits below the larger 26%–30% average changes reported by other analyses for total premiums on marketplaces [2] [1].
2. The clearer headline: insurers’ premiums rising ~26% and benchmark plans ~30%
Analysts with nonprofit and media organizations converged on an estimated ~26% average increase in premiums that insurers are charging in 2026, with Healthcare.gov’s benchmark plans rising about 30% in many states. These numbers come from program-level analyses of insurer filings and projections and represent the amount insurers will bill before accounting for any federal premium tax credits or state actions [1] [4]. That rise reflects a combination of medical cost inflation, insurers’ pricing responses, and market dynamics; it is the most direct measure of insurer pricing pressure, and it is the baseline that determines how much credit assistance must rise to fully shield enrollees.
3. The dramatic difference when enhanced subsidies lapse: average enrollee costs could more than double
When analysts model the expiration of the temporary, enhanced premium tax credits, the headline changes become much larger for consumers. Several reputable reports estimate that currently subsidized enrollees could see their monthly premium payments increase by roughly 114% on average, a figure driven largely by the removal of additional federal credits rather than insurer price-setting itself [5] [6]. Other analyses frame this as enrollees’ out‑of‑pocket costs more than doubling or increasing “by more than 75%,” depending on which cohorts are measured and whether one looks at median versus mean changes [7] [3]. The divergent phrasing reflects differences in sample populations, geographic mixes, and whether the comparison uses proposed versus final rates.
4. Where the numbers diverge — methodology, populations, and timing matter
The variation among sources stems from methodological choices: whether the analysis uses insurer rate requests or enacted final rates, whether it measures average insurer charges or the benchmark plan on Healthcare.gov, and whether it models the presence or absence of enhanced premium tax credits. For instance, the 18% median increase ties to insurer requests (a regulatory filing metric), while 26%–30% figures come from program-wide premium estimates; the ~114% jump references consumer-paid premiums if enhanced credits lapse, not the underlying insurer price change [2] [1] [5]. Publication dates cluster in late October to early November 2025, reflecting the release schedule for 2026 filing and modeling data and underscoring that estimates might be updated as final rates are approved [3] [4] [8].
5. What this means for policy, consumers, and interpretation going forward
For policymakers and consumers the key takeaway is that an insurer premium increase in the mid‑20s percent does not equate to a similar percent increase in consumer costs if subsidies change; subsidy design drives the consumer impact. Outlets and analysts note the same underlying dynamic but emphasize different risks depending on editorial focus: consumer-facing outlets highlight potential double-digit-plus losses in purchasing power for enrollees if enhanced credits end, while technical trackers emphasize insurer filing patterns and median requested changes [3] [2]. Readers should treat the 18%, ~26%, and ~114% figures as complementary pieces of the same story — insurer pricing, marketplace averages, and subsidy‑dependent consumer costs — and assess claims by checking which metric an article explicitly references [2] [1] [5].