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How will health insurance premiums rise for ACA enrollees in 2026?
Executive summary
The core finding across analyses is that 2026 ACA premiums will rise substantially, but the magnitude depends on whether Congress extends enhanced premium tax credits; insurer-driven benchmark premium increases are broadly in the high-teens to mid-20s percent range, while household net payments could more than double if enhanced subsidies expire. Analysts differ on precise numbers—median proposed insurer increases around 18–20% versus KFF and others’ simulations showing a 114% average increase in what subsidized enrollees would pay absent extensions—so the policy choice over subsidies is the dominant driver of consumer outcomes [1] [2] [3].
1. Bold claims: “Double or more” versus “only 20%”—what advocates are saying
Analyses present two contrasting headlines: one set of estimates emphasizes insurer rate requests and approvals, showing aggregate premium levels rising roughly 18–30% driven by medical cost trends and insurer filings, while another set emphasizes the disappearance of enhanced Premium Tax Credits and warns that enrollee out-of-pocket premium payments would more than double on average—an increase of about 114%. The first framing focuses on gross premiums set by insurers and regulators (insurer requests/approvals), while the second focuses on net premiums after subsidies, modeling consumer-facing cost changes if enhanced credits expire. Both are factually grounded in the same exchanges and filings, but they answer different questions: how much insurers charge vs. how much consumers pay [1] [2] [3].
2. What the numbers actually say: ranges, medians and dramatic outliers
State-approved rate changes reported in filings span a wide range—from single-digit increases around 6.7% to state-level approvals above 50%—yielding median insurer proposals near 18% and average proposals near 20% in 2026. Independent modeling by KFF and other trackers estimates gross premium growth could be in the high single digits to mid-teens in some models (CBO-style), but the headline 114% figure represents the change in net premiums for current subsidy recipients if the enhanced tax credits end, moving average enrollee payments from roughly $888 in 2025 to about $1,904 in 2026 in that scenario. Thus, the statistical story depends on whether one reports insurer premium growth or consumer net premium impacts [4] [1] [2] [5].
3. The subsidy cliff: why policy choice drives the consumer picture
All analyses converge on a single structural point: the expiration of enhanced premium tax credits is the decisive factor for many households. If enhanced subsidies lapse, premium tax credits will likely revert to rules that generally cover 100–400% FPL, leaving middle-income families exposed to steep net increases. Models project millions more uninsured over the long term if subsidies are not extended—one estimate flags a potential addition of 3.8 million uninsured by 2035 tied to subsidy expirations—illustrating that small changes in gross premiums can translate into large shifts in coverage and affordability once subsidies change [6] [4].
4. State and enrollment heterogeneity: why some people see small bumps and others face shocks
Premium and net-payment impacts vary sharply by state exchange, plan type, and income. States running their own exchanges show somewhat lower average benchmark increases in some analyses (about 17%) compared with healthcare.gov’s projected 30% benchmark jump in a particular estimate, and approved insurer increases differ by state between 6.7% and 53%. Low-income enrollees who remain eligible for Medicaid or for expanded credits in some states may continue to face low or zero premiums, while middle-income enrollees who lose enhanced credits could face the largest percentage increases in their monthly bills. This creates a patchwork of outcomes driven by state policy choices and local market dynamics [7] [4] [8].
5. Modeling disagreements: different questions produce different answers
Discrepancies reflect methodological choices: some reports aggregate insurer rate filings and regulatory approvals to summarize market-wide premium growth, while others model counterfactual consumer payments under a policy change (expiration of enhanced subsidies). The former yields mid-to-high-teens percentage increases in premiums; the latter yields consumer-facing doubling of net premiums on average in the subsidy-expiration scenario. Analysts also vary in time horizon and assumptions about enrollment churn, plan switching, and behavioral responses, producing divergent projections for uninsured counts and average household impacts—clear evidence that the metric chosen (gross vs. net premium) determines the headline [1] [2] [3].
6. What to watch and the policy stakes for 2026
The immediate levers that will alter the 2026 outcome are Congressional action on enhanced tax credits and state-level regulatory decisions on rate approvals and subsidy routing. If Congress extends enhanced credits, consumer-facing premium shocks will be far smaller despite insurers’ proposed increases; if not, many subsidized enrollees face outsized payment increases and higher uninsured projections. Analysts and policymakers should be explicit about which metric they cite—gross premiums, benchmark plan changes, or net premiums after credits—because each tells a different story about who actually pays and about the political trade-offs in deliberations over extensions [3] [2] [9].