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People who purchase health insurance through the Affordable Care Act Marketplace may see a premium increase of as much as 18% in 2026, according to analysis of preliminary rate proposals by the Peterson KFF Health System Tracker. This hike would be about 11 percentage points higher than last year.
“This is the largest rate change insurers have requested since 2018, the last time that policy uncertainty contributed to sharp premium increases,” the report said. “Based on a more detailed analysis of available documents from insurers in 19 states and the District of Columbia, like in prior years, growth in health care prices stood out as a key factor driving costs in 2026. Insurers cite increasing cost and utilization of high-priced drugs, as well as general market factors, such as increasing labor costs and inflation, as contributing to premium increases.”
Insurers also are considering the impact of the potential expiration of enhanced premium tax credits at the end of 2025. The expiration of enhanced tax credits will lead to out-of-pocket premiums for ACA marketplace enrollees increasing by an average of more than 75%, and some insurers expect healthier enrollees to drop coverage.
Insurers said they wanted higher premiums to cover rising health care costs, including hospitalization, physician care and prescription drug costs. Although tariffs on imported goods could play a role in rising medical costs, insurers said there is a lot of uncertainty around implementation and not many of them cited tariffs as a reason for higher rates.
Republican Gov. Sarah Huckabee Sanders of Arkansas is among several political leaders pushing back on potential premium hikes. She asked the state’s insurance commissioner to reject the proposed rates from Centene and Blue Cross Blue Shield, which filed increases of up to 54% and 25.5%, respectively.
“The Arkansas Insurance Commissioner is required to disapprove of proposed rate increases if they are excessive or discriminatory – and these are both,” she said. “I’m calling on my commissioner to follow the law, reject these insane rate increase and protect Arkansans.”
Meanwhile, the cost of employer-sponsored health care also is expected rise in 2026.
“We do not anticipate trend abatement for 2026,” Ellen Kelsay, president and CEO of Business Group on Health, told the Healthcare Financial Management Association this spring. “In addition to longstanding factors fueling health care trend, emerging macroeconomic factors will likely exacerbate trend in the near-midterm, including the overall economy, the impact of tariffs on health care, government-spending reductions on Medicare/Medicaid and possibly a cost shift to the employer market.”
The proposed ACA rates are preliminary and could change before being finalized in late summer. The analysis includes proposed rate changes from 312 insurers in all 50 states and the District of Columbia.
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