How will health insurance premiums rise after 2025 under ACA?

Executive summary

The most consistent finding across the analyses is that health insurance premiums are likely to rise materially after 2025 unless Congress extends the ACA’s enhanced premium tax credits, with estimates ranging from modest median increases to dramatic doubling for many subsidized enrollees. Different analysts attribute the rise to two overlapping drivers—the scheduled expiration of expanded subsidies and rising medical cost pressures—but they disagree on the size of the impact for particular groups and states ^{[1] [2] [3]}.

1. Stark contrasts: double‑digit nationwide increases versus catastrophic spikes for subsidized enrollees

Analysts present a range of aggregate projections that do not conflict so much as spotlight different populations. One summary of insurer filings finds a median proposed premium increase of about 18% nationally for 2026, driven by insurers’ rate requests tied to expected medical inflation and changes in the risk pool; several states show proposals above 20% (p3_s1, 2025-09-30). By contrast, estimates focused on current subsidized enrollees show much larger changes if enhanced tax credits expire: KFF projects a 114% average increase in premium payments for subsidized households (from $888 to $1,904 annually), and other summaries report an average near a 30% rise in 2026 from insurer rate increases and subsidy loss, with some households facing far larger increases ^{[1] [2] [4]}. These figures reflect different baselines—proposed plan prices versus out‑of‑pocket premium costs after tax credits—and therefore illuminate who bears the burden.

2. Why insurers say rates must rise: costs, risk pool, and the "subsidy cliff"

Insurers and market filers cite two primary mechanisms for upward pressure: medical cost growth and the technical effect of losing broad subsidies that currently keep healthier people enrolled. The marketplace filings analysis attributes about 7–8% medical cost growth for 2026 and additional insurer adjustments—commonly adding 1–14 percentage points—to account for a sicker remaining pool if subsidies expire ^[3]. Policy analyses echo this mechanism: if subsidies are not extended, many lower‑cost enrollees would drop coverage, leaving premiums that reflect a higher‑cost set of remaining enrollees and prompting large rate increases targeted at subsidized households ^{[3] [4]}. The interaction of cost inflation and enrollment composition is central to the forecasts.

3. Human scale: who loses coverage, and how many could be affected?

At the household level, analysts warn of concentrated pain. Projections tied to subsidy expiration estimate nearly 5 million people could become uninsured in 2026, and some macro studies link those coverage losses to broader economic impacts such as roughly 339,100 lost jobs, reflecting reduced health‑care spending and employer responses ^[5]. For certain income bands and older adults the changes are particularly acute: analyses show scenarios where out‑of‑pocket premiums jump by hundreds of percent, with cited examples of increases of over 400% for some low‑income categories and alarming one‑off examples of households facing more than $20,000 in added annual costs in worst‑case tabulations ^{[3] [6]}. Vulnerability is concentrated among middle‑income earners who do not qualify for Medicaid but earned too little to be protected without enhanced credits.

4. Small offsets and nuance: not everyone faces the worst outcomes

Other official summaries offer a more measured view: CMS’s plan‑level fact sheet on 2026 marketplace offerings projects modest increases in monthly premiums for the lowest‑cost plans—about $13 to $50 per month on average after tax credits—and notes that tax credits will continue to cover a substantial share of costs for eligible enrollees ^[7]. This framing emphasizes that even with higher sticker prices, many enrollees who remain eligible for subsidies will still see substantial federal assistance, and that premium levels in some cases would remain lower than in early 2020. The divergence between this view and the KFF/advocacy projections stems from assumptions about congressional action, enrollment behavior, and whether analyses are reporting premiums before or after credits ^{[7] [2]}.

5. Conflicting incentives and possible agendas behind the numbers

The two dominant narratives reflect distinct institutional vantage points. Insurer filings and the Commonwealth Fund emphasize actuarial realities and cost drivers, highlighting state‑by‑state rate requests and medical cost trends ^[3]. KFF and policy analysts emphasize consumer impacts and the political stakes of letting the enhanced credits expire, producing headline figures about doubling of out‑of‑pocket payments and millions losing coverage ^{[2] [5]}. Both perspectives are factual but serve different audiences: insurer data informs solvency and pricing, while advocacy‑oriented analyses stress household affordability and labor‑market consequences. Readers should note these differing emphases when assessing which projection best predicts their personal risk.

Bottom line: the best‑supported conclusion across the analyses is that premiums will rise after 2025, with the magnitude depending critically on whether Congress extends enhanced premium tax credits and on near‑term medical cost trajectories; some enrollees could see modest increases, while subsidized consumers face the risk of premium doubling or worse if subsidies lapse ^{[3] [2] [1]}.