ACA Marketplace Insurers Propose Biggest Premium Hikes Since 2018

Rising healthcare costs, expensive specialty drugs, and hospitals and clinics facing staffing challenges and uncertainty about federal help are causing significant proposed premium increases in the ACA marketplaces for 2026, according to a recent Kaiser Family Foundation (KFF) analysis.

KFF found that 312 insurers across all 50 states and the District of Columbia have submitted rate filings projecting a premium increase of 18%—roughly 11% higher than last year and the largest nationwide jump since 2018. On average, insurers are requesting about a 20% increase in premiums.

Based on the analysis, insurers noted that multiple factors drive these increases, with rising healthcare costs and the potential expiration of enhanced premium tax credits among the most significant. Healthcare costs, including hospitalizations, physician services and prescription drugs, continue to grow each year. Specialty medications, such as GLP-1 drugs including semaglutide—sold under both Wegovy and Ozempic—used for diabetes and weight management, are also a major contributor to rising pharmacy expenses.

Proposed premium increases in the ACA Marketplace for 2026 surge due to rising healthcare costs, specialty drug prices and subsidy uncertainties, according to a recent KFF analysis.

Kaiser Foundation Health Plan of Washington highlighted the trend in GLP-1 utilization, stating that they expect “utilization and script mix to increase by 18% in 2025 and 7% in 2026.”

MVP Health Care of Vermont noted they came across similar trends with their commercial population costs for GLP-1 drugs rising approximately 25% to 30% per quarter for each quarter in 2024.

According to IQVIA, spending on prescription drugs grew 9.9% in 2023, driven in large part by higher costs for specialty medications like GLP-1 drugs used for diabetes and weight management. This trend is expected to continue through 2028, suggesting that rising drug costs will keep putting pressure on ACA Marketplace premiums.

Beyond prescription drugs, insurers also cited labor costs, provider consolidation and inflation as factors driving premiums higher, highlighting the broader pressures within the healthcare system.

Health New England, Inc. (Massachusetts) stated, “Physicians and hospitals are facing economic pressures caused by supply chain shortages, overall inflation and continued workforce challenges. As a result, providers are seeking higher reimbursement for their services.”

In addition to these cost pressures, uncertainty over federal policy and premium subsidies is influencing insurers’ rate filings.

The analysis found that a significant reason for higher premiums could be due to the potential end of enhanced premium tax credits after 2025. Without these subsidies, consumers buying insurance through the Marketplace could see their out-of-pocket costs go up by more than 75%. Healthier people could also drop their coverage, leaving the remaining group with higher average costs.

In addition, UnitedHealthcare’s (UHC) Maryland plan shared in the report that an adjustment of 1.044 was applied to account for the expiration of enhanced premium subsidies through the ARPA and extended by the Inflation Reduction Act (IRA).

“Due to the expiration of the enhanced premium subsidies effective 1/1/2026, UHC anticipates a decline in enrollment due to higher post-subsidy premiums,” UHC’s representative said. “Healthier members are expected to leave at a disproportionately higher rate than those with significant healthcare needs, increasing market morbidity in 2026.”

Other federal policies, including the ACA Marketplace Integrity and Affordability rule and potential Republican budget provisions related to cost-sharing reductions, were also noted by insurers but are expected to have smaller impacts compared with medical trend and subsidy changes.

Premium increases vary widely across insurers and states, reflecting the complexity of the ACA marketplaces.

Among the 312 insurers reviewed nationally, proposals ranged from a 10% decrease to a 59% increase. It was found that roughly 125 insurers requested increases of at least 20%, while four insurers proposed lowering premiums. KFF’s review of 105 insurers across 19 states and the District of Columbia found slightly lower median increases of 15%.

For millions in ACA Marketplace plans, subsidies are key to keeping coverage affordable.

Currently, 92% of enrollees receive premium support, but if enhanced tax credits expire, out-of-pocket costs could rise quickly and intensely, and some people could drop coverage.

All in all, rising medical and pharmacy costs, labor pressures and policy uncertainty—especially around specialty drugs such as GLP-1s—are driving 2026’s proposed premium increases. Policymakers and consumers will be watching closely, as changes to tax credits could greatly affect affordability and access.