ACA Health Insurance Premiums Surge in 2026 as Subsidies Expire

The expiration of subsidies that previously helped lower costs for Affordable Care Act (ACA) health insurance plans is resulting in a significant increase in premiums for 2026. On average, ACA premiums are increasing by approximately 144%, with some consumers experiencing doubling of premiums and deductibles compared to 2025. This substantial rate hike is driven by rising overall healthcare costs and insurers adjusting premiums due to concerns about a sicker, older enrollee pool as younger, healthier individuals may forego coverage due to high costs. Market dynamics indicate a potential reduction in insured individuals, as the Urban Institute projects that 4.8 million people could become uninsured next year because of unaffordable premiums, high deductibles, and cost-sharing requirements. Some consumers may respond by downgrading their plans from Silver to Bronze or shifting to Medicaid or employer-sponsored coverage if available. As of late November 2025, about 5.8 million people had enrolled in marketplace plans for 2026, slightly ahead of last year’s enrollment pace. Despite a record enrollment of 24.3 million people in 2025, this year’s landscape reflects the impact of subsidy expirations and failed Senate votes on legislative proposals designed to mitigate premium increases. The two competing Senate proposals aimed at countering premium hikes did not secure enough votes, leaving the market subject to higher costs without legislative relief. Consumers who have not yet selected a 2026 plan face automatic re-enrollment into similar plans but have a final enrollment deadline in mid-January for coverage starting February. These developments underscore key considerations for insurers, regulators, and market participants regarding affordability, risk pool composition, and enrollment behaviors. The evolving ACA marketplace in 2026 highlights the challenges of sustaining affordable coverage amid subsidy changes and healthcare inflation.