ACA Marketplace Premiums Surge 144% in 2026 as Subsidies Expire

Affordable Care Act (ACA) health insurance premiums are set to increase by an average of 144% in 2026 due to the expiration of key subsidies that previously reduced costs for consumers. This dramatic rise translates into doubled or more premiums and deductibles for many enrollees compared to 2025, impacting the affordability of marketplace coverage nationwide. Insurers have raised rates not only in response to general healthcare inflation but also to mitigate the risk of adverse selection, as higher premiums may discourage younger, healthier individuals from maintaining coverage, leading to a sicker insurance pool. The Urban Institute projects that approximately 4.8 million Americans may lose health insurance in 2026 because they are unable to afford the increased premiums, deductibles, or cost-sharing requirements. Some affected individuals may seek employer-sponsored coverage, qualify for Medicaid, or downgrade to less expensive plans such as Bronze-tier policies. Despite these challenges, enrollment in marketplace plans reached about 5.8 million as of late November 2025, slightly exceeding the corresponding period in the previous year. Insurers’ rate hikes follow a year where ACA enrollment peaked at roughly 24.3 million people without significant premium changes. Legislative efforts to address the pending cost increases through proposals in the Senate failed to pass, which has left the marketplace without new measures to curb the rising expenses. This development could further heighten financial pressures on consumers and the risk pool dynamics. Consumers who have not yet selected their 2026 coverage face a December 15 deadline for new enrollments effective January 1, 2026, with a later enrollment window available until January 15 for coverage starting February 1. Existing enrollees who do not actively choose a plan will be automatically re-enrolled in similar plans. These changes underscore important considerations for policymakers, insurers, and healthcare providers aiming to navigate ongoing market and regulatory shifts within the ACA framework.