ACA Marketplace insurers seek 18% median premium hikes for 2026

The Peterson-KFF Health System Tracker published its August 6, 2025 analysis of 312 insurer rate filings across all 50 states and Washington, D.C., finding a median proposed premium increase of 18% for 2026 ACA Marketplace plans. That compares to a 7% median increase for 2025, making it the largest rate request since 2018. Of the 312 filings, 125 insurers proposed increases of at least 20%, while only four proposed premium decreases.

The 18% median figure reflects initial proposals, not final approved rates. States and the federal government review and often negotiate final rates before open enrollment begins each fall.

The Centers for Medicare and Medicaid Services confirmed that 24,166,491 consumers selected 2025 Marketplace coverage as of January 15, 2025, a record high. That number included 3.9 million new enrollees and doubled enrollment compared to the 2021 open enrollment period.

KFF researchers found that approximately 92% of marketplace enrollees received a premium tax credit in 2025, meaning the vast majority of the 24 million chose plans assuming subsidized premiums would continue.

The Inflation Reduction Act of 2022 extended enhanced premium tax credits through December 31, 2025. Congress didn't pass legislation to extend them further, so those credits expired at the start of 2026. Peterson-KFF analysts found that insurers built approximately 4 percentage points into their 2026 rate requests specifically because they expected healthier enrollees to drop coverage once their subsidies disappeared, leaving a sicker and more expensive risk pool behind.

The mechanism is self-reinforcing: when healthier people leave, the average cost of remaining enrollees rises, which pushes premiums higher, which causes more healthy people to leave. KFF health policy researcher Cynthia Cox described this cycle as one of the central risks facing the Marketplace in 2026.

The Urban Institute projected that 4.8 million more people would become uninsured in 2026 if enhanced credits expired, with subsidized Marketplace enrollment falling from 19 million to 11.7 million, a 38% drop. Eight states including Georgia, Texas, Mississippi, and Tennessee faced projected enrollment declines of more than 50%.

KFF later confirmed that ACA enrollment fell to 23.1 million in 2026, a 5% decrease from 2025, as the expiration of enhanced credits triggered a coverage contraction that analysts had warned about throughout 2025.

KFF's analysis found that tariffs on imported pharmaceuticals and medical equipment contributed approximately 3 percentage points to insurers' 2026 rate requests. Several insurers in their public filings cited uncertainty over whether pharmaceutical tariffs would take effect, and priced in that risk rather than waiting for final trade policy determinations.

This embedded trade policy directly into household health insurance premiums: a worker paying $400 per month for ACA coverage in 2025 could expect to pay roughly $12 more per month just from tariff-driven drug cost uncertainty, on top of all other increases.

Specialty drugs, particularly GLP-1 medications like Ozempic (semaglutide) and Wegovy (semaglutide for weight loss), added significant upward pressure to both marketplace and employer-sponsored insurance costs. Blue Cross Blue Shield research found that covering GLP-1 medications drives employer premiums up as much as 14% even when access is limited to highest-need patients. GLP-1 drug claims rose from 6.9% of pharmacy claims in 2023 to 10.5% in 2025.

The Peterson-KFF Health System Tracker confirmed GLP-1 demand as one of its eight key trends shaping 2026 healthcare costs, alongside labor costs, hospital consolidation, and the expiration of enhanced credits.

KFF confirmed that the average marketplace deductible grew by approximately $1,000 per person in 2026, rising 37% from $2,759 in 2025 to $3,786 in 2026. The share of enrollees in bronze plans jumped from 30% to 40% of total plan selections as consumers traded lower monthly premiums for higher out-of-pocket costs at the point of care.

Silver plan enrollment fell to its lowest level in program history, dropping from 57% to 43% of enrollees. The Commonwealth Fund's Sara Collins described the shift as a fundamental change in how Americans access care through the marketplace.

CVS Health announced in May 2025 that its Aetna subsidiary would exit the ACA individual exchanges after 2025, affecting approximately 1 million members across 17 states. The Cigna Group followed in April 2026, announcing it would exit exchanges in 11 states serving 369,000 members. Centene, the largest marketplace carrier, reported its ACA membership fell from 5.6 million to 3.6 million in Q1 2026.

Insurer exits concentrate market power in remaining carriers, reducing consumer choice and competitive pressure on premiums. In markets where one insurer dominates, regulators have less leverage to push back on rate requests.

Employer-sponsored insurance, which covers approximately 160 million Americans, faced separate but linked cost pressures in 2025. Mercer's 2025 National Survey of Employer-Sponsored Health Plans found employer plan costs rose 6% for the third straight year, with family premiums reaching $25,572, up from $23,028 in 2024. Employers projected a further 9% increase for 2026 without cost-management action.

The Peterson-KFF brief comparing ACA marketplace and employer-sponsored insurance costs found both markets face common drivers: hospital consolidation, prescription drug costs, and post-pandemic utilization rebounds that hit claims harder than insurers priced in 2023 and 2024.

The Congressional Research Service published a detailed FAQ on enhanced premium tax credits and 2026 premiums in September 2025, outlining legislative options available: Congress could extend credits at current levels, phase them down, or let them expire entirely. The report noted that the reconciliation package moving through Congress in mid-2025 did not include an extension of enhanced ACA credits, despite lobbying from hospital associations, insurance commissioners, and consumer advocacy groups.

The Center on Budget and Policy Priorities identified five key policy changes hitting the ACA marketplace simultaneously in 2026, warning that the combination of subsidy expiration, insurer exits, tariff-driven cost increases, and GLP-1 drug costs represented an unprecedented policy-driven disruption distinct from normal market fluctuations.