Delaware ACA Premiums Face Sharp Increases Amid Rising Costs and Subsidy Uncertainty

Delaware is facing some of the highest proposed premium increases in the Affordable Care Act (ACA) marketplace for 2026, with three insurers requesting hikes exceeding 30%, outpacing the national median increase of 18%. These filings submitted to state regulators reflect rising health care costs and the potential expiration of enhanced federal premium tax credits set to end in 2025, which have substantially subsidized ACA coverage affordability. The Peterson Center on Healthcare and KFF analysis highlights inflation, labor costs, and the increased use of costly prescription drugs, such as GLP-1 medications, as key drivers behind the premium surge nationally.

However, the Delaware Department of Insurance reports that GLP-1 drugs have not significantly impacted premiums statewide due to manufacturer rebates that offset costs, despite usage nearly doubling from 2020 to 2023. The department plans a broader pharmacy spending analysis covering all medications in the fully insured commercial market to better understand prescription drug impact on premiums.

Delaware’s healthcare spending rose sharply by 9.1% between 2022 and 2023, reaching nearly $11 billion, with hospital inpatient care and prescription drugs driving most of the increase. In response, the state established the Diamond State Hospital Cost Review Board in 2024 to monitor and control hospital spending, but its efforts have faced legal and operational challenges, including a lawsuit by ChristianaCare and leadership turnover.

The potential lapse of enhanced premium tax credits could lead to higher premiums if healthier individuals drop coverage, tightening the insurance risk pool and compounding affordability concerns. Insurers have factored this uncertainty into their 2026 rate filings, signaling ongoing financial pressure on the ACA marketplace.

These developments underscore significant regulatory, cost management, and subsidy-related challenges in Delaware’s ACA market, with implications for insurer pricing strategies, consumer affordability, and state healthcare policy oversight going forward.