Regional differences in ACA plan costs 2026 with subsidies?
Executive summary
Geography will strongly condition how much people pay for ACA plans in 2026 because federally set subsidy rules interact with widely varying local premium increases and state-level actions: average benchmark premiums rose sharply nationwide, but states that supplement federal aid or negotiated lower rate changes will see much smaller net costs for enrollees [1] [2]. Whether Congress extends enhanced premium tax credits will be the dominant driver — if enhancements lapse, most enrollees still get federal subsidies but out-of-pocket premium payments are projected to jump sharply in many regions [3] [1].
1. Premiums are up everywhere, but the size of the increase varies by region
National data show benchmark “silver” plan premiums rising substantially for 2026 — KFF reported an average 26 percent increase in benchmark premiums — but that national average masks large state and regional variation driven by insurer pricing and local market conditions [1]. State rate filings reviewed by analysts reveal insurers’ assumptions and regional adjustments — for example, insurers in some states applied specific upward adjustments tied to subsidy expirations while others projected smaller statewide average increases or even decreases in underlying premium assumptions [4].
2. Federal subsidies set the floor, but regional premiums set the sticker price
Subsidies are calculated from the second-lowest-cost silver plan in each region (the “benchmark”), and federal rules determine the share of income an enrollee must pay — a sliding scale tied to the federal poverty level — so regional benchmark premium changes translate directly into subsidy amounts and net costs for households [5]. The Committee for a Responsible Federal Budget explains that under current law the pre-subsidy benchmark premium estimates and the statutory caps on required enrollee contributions determine subsidy size, meaning a region with a much higher benchmark premium produces larger subsidies but also larger pre-subsidy costs overall [5].
3. The subsidy cliff (or rollback) is the biggest statewide wild card
Analysts warn that expiration of the enhanced premium tax credits will materially raise what subsidized enrollees pay: KFF estimates average premium payments would more than double if enhanced credits expire, increasing consumers’ net share by roughly $1,016 on average in 2026 under current law assumptions [3] [6]. That national projection will play out differently by state because regions with higher premium increases or fewer state-level protections will see larger dollar and percentage changes in what residents pay [3] [1].
4. States can blunt or amplify federal changes — California as a case study
Some states are mitigating federal uncertainty by using state subsidies or active rate negotiation; Covered California projected a relatively modest preliminary weighted average rate increase of 10.3 percent and highlighted state-funded assistance that cushions consumers — an example of how a state marketplace can reduce net regional cost shocks [2]. In contrast, markets without state supplements or with larger insurer rate hikes will leave residents facing much bigger post-subsidy bills [2] [1].
5. Insurer behavior and enrollment responses will differ regionally
Rate filings show insurers in some states explicitly model enrollment declines if enhanced subsidies lapse, expecting fewer enrollees and altered risk pools that can feed back into premiums — UnitedHealthcare and others flagged anticipated enrollment drops tied to subsidy changes in filings [4]. Where insurers project enrollment erosion, consumers who remain may face higher premiums; where competitive markets and state interventions keep enrollment steadier, increases may be smaller [4].
6. Practical implications and where to get local answers
For individuals, zip-code–level preview tools and marketplace calculators are the practical way to see regional outcomes: Healthcare.gov’s “see plans” preview and KFF/other subsidy calculators allow users to compare estimated premiums and tax credits in specific counties, which is essential because national averages obscure concrete local differences [7] [8]. Reporting and advocacy outlets also document real-world consumer impacts — from people forced to downgrade plans to state policy efforts to preserve affordability — underscoring that outcomes will be uneven across regions [9] [2].
Limitations: available reporting provides strong national and some state examples but does not map every county or insurer; precise 2026 out-of-pocket costs for an individual remain dependent on local plan offerings and whether Congress modifies subsidy law [5] [7].