Newly Unveiled ACA Premiums Show 26% Average Increase Before Subsidy Expiration

Prices for health coverage on the Affordable Care Act (ACA) marketplaces became public Tuesday, showing increases of 30% in states using the federal Healthcare.gov marketplace and 17% in states running their own marketplaces—averaging out to a 26% increase in 2026, according to KFF.¹ These increases do not include the effects of the expiring premium tax credits, which could further hike the costs enrollees must pay.

The prices are based on the benchmark for the second-lowest cost plan in the silver metal tier. They reflect the amount insurers are charging, not what enrollees will pay, so the full picture of premiums is still unclear as Congress remains shut down due to disagreements on whether to continue the increased premium tax credits that make plans more affordable for many marketplace enrollees but are set to expire at the end of the year.² The shutdown has stretched to over a month as Democrats demand an extension of the subsidies, but Republicans will not act on the subsidies before the government is reopened.

If the subsidies are not extended, enrollees currently receiving the tax credits would see their monthly premium payments increase by an average of 114% next year—more than double.¹ Those with incomes over 4 times the federal poverty level would not receive any financial assistance, and those with incomes less than that would see their assistance reduced. This latter group could still switch to a bronze plan with a very low premium, but these could entail deductibles of more than $7000 instead of the silver plans they may currently have with a reduced deductible as low as $100.

KFF’s analysis attributes the planned premium hikes to several trends, including ever-rising hospital costs, the increasing uptake of costly weight management drugs such as glucagon-like peptide 1 receptor agonists, and the looming threat of tariffs on imported drugs and devices. These trends are affecting the prices of employer-sponsored coverage as well, but ACA marketplace employers are also factoring in the likelihood that healthy people will forgo coverage if the tax credits expire, which KFF describes as driving rates an average of 4 percentage points higher than they otherwise would be.

The increases revealed in the rates for 2026 are even higher than those projected over the summer based on proposed rate filings, which predicted a median premium increase of 18% and an overall increase in out-of-pocket costs of more than 75% if the tax credits expire.³ Analyses from earlier this year also forecast that expiration of the subsidies could increase the number of uninsured in the US by 4.2 million over the next decade.

Amid the subsidy quarrel in Congress, health insurers and many policy experts are encouraging younger and healthier Americans to still purchase health insurance, noting the unpredictability of disease and injury, as well as emphasizing the need to prevent a “death spiral” in the insurance market where healthy enrollees exit and sicker beneficiaries with high costs remain.⁴ Others are calling for insurance to be used as a means to protect against extremely high charges; these “catastrophic” health insurance plans were heavily restricted under the ACA, but CMS recently loosened regulations on these, anticipating the subsidy expiration and premium increases in 2026.⁵

“The purpose of insurance is to protect against major financial risks,” Ge Bai, PhD, CPA, professor of accounting and health policy and management at Johns Hopkins, told The American Journal of Managed Care®.⁶ “When it is used to cover routine services—where there is little financial risk to begin with—the added complexity and intermediary markup often outweigh the benefits of risk pooling…. Unless insurance returns to its core function of covering only economically insurable events, relying on it for most health care transactions will remain inefficient.”

The open enrollment period for 2026 begins on November 1 and runs through mid-December, meaning enrollees who pick a plan before a resolution to the subsidy squabble can change their choice until the period ends.²

References

1. Cox C. ACA insurers are raising premiums by an estimated 26%, but most enrollees could see sharper increases in what they pay. KFF. October 28, 2025. Accessed October 29, 2025. https://www.kff.org/quick-take/aca-insurers-are-raising-premiums-by-an-estimated-26-but-most-enrollees-could-see-sharper-increases-in-what-they-pay/

2. Abelson R, Sanger-Katz M. Obamacare prices become public, highlighting big increases. October 29, 2025. Accessed October 29, 2025. https://www.nytimes.com/2025/10/29/health/obamacare-prices-health-insurance.html

3. Jeremias S. ACA premiums set for significant jumps in 2026, threatening affordability. AJMC^®. August 13, 2025. Accessed October 29, 2025. https://www.ajmc.com/view/aca-premiums-set-for-significant-jumps-in-2026-threatening-affordability

4. Simmons-Duffin S. Why the ACA needs young people — and the looming ‘death spiral’ for health insurance. NPR. October 26, 2025. Accessed October 29, 2025. https://www.npr.org/sections/shots-health-news/2025/10/26/nx-s1-5577940/health-insurance-government-shutdown-aca-open-enrollment-death-spiral

5. Expanding access to health insurance: consumers to gain access to “catastrophic” health insurance plans in 2026 plan year. News release. CMS. September 4, 2025. Accessed October 29, 2025. https://www.cms.gov/newsroom/fact-sheets/expanding-access-health-insurance-consumers-gain-access-catastrophic-health-insurance-plans-2026

6. Bai G, Mattina C. Managed care reflections: a Q&A with Ge Bai, PhD, CPA. Am J Manag Care. 2025;31(10):530-531. doi:10.37765/ajmc.2025.89804