Each spring and summer, health insurers submit rate filings to state regulators to justify premium changes for the coming calendar year. Several factors drive premium changes, and usually the cost of medical care (the prices of health services and the amount of care people are receiving) is the primary driver of premiums. However, heading into 2026, there are also policy changes that insurers expect will drive up their costs and, thus, increase premiums beyond what they would otherwise charge.
Some of the factors that insurers cite as contributing to higher rates next year include:
- Enhanced premium tax credits that make coverage more affordable will expire at the end of 2025, driving up out-of-pocket premium payments by over 75% on average. This is expected to cause healthier enrollees to drop their coverage and create a sicker risk pool. An earlier Peterson-KFF Health System Tracker analysis showed the expiration of enhanced premium tax credits raised proposed rates by an additional 4 percent, on average.
- Tariffs could drive up the cost of some drugs, medical equipment, and supplies. Some insurers report that tariffs—and the uncertainty around them—are driving rate increases about 3% higher than they otherwise would be.
Additionally, many insurers submitted proposed rates before the budget reconciliation legislation passed and the Centers for Medicare and Medicaid Services (CMS) finalized the Marketplace Integrity and Affordability rule. The legislation and rule make changes to how the Marketplaces operate and how people are enrolled. These changes were only finalized in early July and late June, respectively, and it is not yet clear how insurers may respond.
Early indications are that individual market insurers will be increasing premiums in 2026 by more than they have since 2018, the last time policy uncertainty contributed to sharp premium increases. Across 105 ACA Marketplace insurers in 20 markets (19 states and the District of Columbia), premiums are increasing by a median of 15%. These filings are still preliminary and may change.
What is the driving premium increases?
As in most years, rising healthcare costs – both the price of care and increased use – are a significant driver for increasing rates going into plan year 2026. The costs of health care services like hospitalizations and physician care, as well as prescription drug costs tend to go up every year, and insurers often raise premiums to cover their increased costs. For 2026, insurers commonly say the underlying cost of health care (medical trend) is similar to last year’s reported 8%. A number of insurers mention GLP-1 drugs having an upward effect on their costs, as well as health care labor market pressures impacting provider contract negotiations.
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Another change expected for next year is the enhanced tax credits are set to expire. The vast majority of insurers are mentioning this in their rate filings, with most saying they will raise premiums by an additional 4% than they would if the enhanced tax credits were renewed. For the last five years, enhanced premium tax credits have increased the amount of financial assistance enrollees in ACA Marketplace coverage receive, lowering their monthly premium payments. If Congress takes no action to renew these enhanced tax credits, enhanced subsidies will expire at the end of 2025, which will cause premium payments for subsidized enrollees to increase by over 75% starting in January 2026. Insurers expect a large share of enrollees to leave the market, and that those enrollees will be healthier on average, thus leaving the risk pool sicker on average.
Less commonly mentioned are the impact of tariffs, which insurers mention may impact the cost of pharmaceuticals. Of the insurers that publicly quantify the impact of tariffs, the impact on premiums is about 3%, on average. (For more on the impact of tariffs on premiums, see this analysis.)
Another factor creating uncertainty in the rate filing process is the implementation of the Trump ACA integrity rule. However, based on what insurers have filed so far, this generally does not seem to be driving rate changes in either direction. Insurers and state regulators are still finalizing rates for the upcoming plan year, so these filed premium increases may change.
Insurers vary in the assumptions that they are making about premium drivers in 2026. There are other factors not mentioned here that vary market to market that could play a role in premium changes.
How are premiums going to change in 2026?
Across over 100 ACA Marketplace insurers, premiums are rising by a median of 15% in 2026
Most ACA Marketplace insurers are requesting premium increases in the 10-20% range for 2026. But more than a quarter (27%) of insurers are proposing premium increases of 20% or more for 2026. In recent years, premiums in this market have been relatively flat or grown only modestly for several years. Last year, just 3% of insurers increased premiums by 20% or more. No insurers have requested rate decreases for 2026, whereas in recent years at least some insurers did decrease premiums.
In this analysis, a premium increase for a given insurer in the individual market is its weighted average percent change across all of its products within a state (i.e., bronze, silver, gold, and platinum plans). These weighted average premium changes may differ from the percent change in the benchmark silver plan, which is the basis for federal subsidies. For context, the median proposed rate increase was 7% in 2025, while the average increase in benchmark silver premiums was about 4% in 2025.
Finalized 2026 rate changes are expected to be published in late summer, and individuals will be able to see how their plan’s premium is changing shortly before open enrollment starts November 1.
Note: This analysis looks at insurers from the District of Columbia, and the following 19 states: Connecticut, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon, Rhode Island, Texas, Vermont, and Washington.
The Peterson Center on Healthcare and KFF are partnering to monitor how well the U.S. healthcare system is performing in terms of quality and cost.
