ACA Marketplace Health Insurance Premiums Set for Double-Digit Increases in 2026

Health insurance premiums for Affordable Care Act (ACA) marketplace plans are projected to increase significantly in 2026, with insurers requesting double-digit rate hikes. Major providers such as Blue Cross & Blue Shield in Illinois and Texas are seeking increases as steep as 27% and 21%, respectively, with similar trends in states like Georgia, Rhode Island, and Washington.

These hikes represent the largest spike in ACA premiums since 2018. Insurers attribute the rate increases to rising healthcare costs driven by factors including increased emergency room visits, higher drug prices influenced by tariffs, and expanded use of behavioral health services among enrollees.

Concurrently, the expiration of federal subsidies enacted in 2021 is expected to remove key affordability supports, leading to higher out-of-pocket costs for many consumers. This reduction in subsidies combined with new sign-up requirements may also decrease marketplace enrollment, concentrating risk among remaining enrollees who tend to be sicker and more costly to insure.

The combined effect of cost escalation and subsidy cuts underscores challenges for payer financial sustainability and highlights ongoing tensions in balancing coverage affordability with healthcare spending growth. Insurers and analysts suggest careful monitoring as these dynamics could influence regulatory decisions and market stability in the ACA landscape moving forward.