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How do US health insurance premiums compare to other developed countries?
Executive summary
U.S. premiums are substantially higher and rising faster than in many peer nations: employer-family premiums averaged nearly $27,000 in 2025 (a 6% rise) and individual marketplace premiums are spiking in 2025–26, with some ACA enrollees facing year-over-year increases as large as 59% or more depending on subsidy changes [1] [2]. Analysts and agencies point to drug prices, insurer market concentration, and the scheduled rollback of expanded premium tax credits as principal drivers of the U.S. trend [2] [3] [4].
1. U.S. headline numbers: premiums are high and climbing
Employer-sponsored family premiums rose to nearly $27,000 in 2025, up about 6% from 2024, and have increased 26% over five years according to KFF-survey reporting cited by Reuters [1]. For individual-market buyers, open-enrollment reporting shows dramatic spikes: some ACA plans are seeing premium jumps up to 59% entering 2026 in part because of policy changes that affect subsidies [2] [4].
2. Why these U.S. costs matter compared with other developed countries
Available sources do not provide direct cross-country premium tables in this set, but they frame U.S. premiums as anomalously large because of higher unit prices for care (hospitals, drugs) and private-market structure rather than greater use of services—factors that typically make U.S. per-person premiums and out-of-pocket burdens higher than in many high-income peers [2] [3]. The reporting emphasizes system drivers—price levels, prescription drug spending (including GLP-1s), and market concentration—rather than utilization differences [2] [1] [3].
3. Policy choices and the “subsidy cliff”: a near-term amplifier
Several sources document that enhanced premium tax credits introduced in 2021 substantially lowered marketplace premiums for many enrollees, and their scheduled expiration at end of 2025 would sharply increase what unsubsidized enrollees pay in 2026 — creating a “subsidy cliff” for those above income thresholds [4] [5]. The Commonwealth Fund finds median proposed marketplace premium increases of 18% for 2026 filings, largely tied to that policy change [4]. CMS, by contrast, projects the average lowest-cost HealthCare.gov plan after tax credits will still be about $50/month for eligible enrollees in 2026, highlighting differences in who gets assistance and how much [6].
4. Who bears the burden: employer-covered vs. marketplace enrollees
Most Americans (about 165 million) receive employer-sponsored coverage, where premiums are rising but more modestly in 2026 projections (around a 6–7% increase or up to 12.3% for some federal plans), because employers typically share costs [1] [7] [8]. By contrast, those buying individual marketplace plans face larger percentage swings—especially if they lose enhanced subsidies—leading to stark sticker shock in news accounts of individuals whose premiums doubled or tripled [9] [10] [2].
5. Structural drivers: prices, drugs, and market concentration
Experts point to service and drug price inflation—particularly the rapid uptake and cost of GLP-1 weight-loss drugs—as major cost drivers that insurers pass through to premiums [1] [7]. The U.S. market’s insurer concentration in many states also correlates with higher premiums and fewer choices for consumers, a dynamic highlighted in a GAO analysis [3]. These structural elements help explain why U.S. premiums are larger and more sensitive to policy shifts than in many countries with greater price controls or single-payer elements [2] [3].
6. Conflicting signals in the reporting — who benefits from subsidies?
There is disagreement in tone and emphasis across sources: CMS emphasizes that after tax credits many eligible marketplace enrollees will still see low average premiums (about $50/month for the lowest-cost plan on HealthCare.gov in 2026), while media reporting stresses widespread sticker shock and large increases for those losing enhanced credits [6] [10] [9]. Commonwealth Fund filings and Reuters coverage align in warning of sizable rate proposals and consumer impacts if Congress does not act to extend credits [4] [10].
7. What this means for comparisons with other developed countries
Available sources do not present a side‑by‑side, country-level premium comparison in this dataset, so definitive ranked comparisons are not in current reporting. However, the cited analyses make clear that U.S. premiums are driven upward by higher unit prices, prescription drug spending, and market structure—factors that typically set the U.S. apart from many peer nations with stronger price regulation or broader public coverage [2] [3].
Limitations: these sources are U.S.-focused and do not contain comprehensive international premium tables; statements about other countries’ premiums or rankings are therefore not found in current reporting (not found in current reporting).