What to Expect in 2026: Rising Marketplace Premiums

What Members Are Affected

Exchange coverage refers to health insurance plans purchased through ACA marketplaces such as HealthCare.gov or state-run exchanges. These platforms allow individuals, sole practitioners, and small firms to compare standardized options, and eligible enrollees may receive premium tax credits (subsidies) that reduce monthly costs.  That describes most AIA members.

Most medium and large firms do not provide medical coverage to employees through the exchanges.  Insurers and benefit consultants predict that these firms will experience the largest cost increases in the last 15 years.   For ACA-compliant small-group employer plans, filings show a median proposed increase of roughly 11 percent [2].  Large firms that self-insure health coverage are expecting a 9% increase in claims costs which would mean a 6.5% increase in employees’ out-of pocket costs [7].

Why Premiums Are Rising

• Underlying insurer cost pressures.Insurers cite inflation, medical utilization, provider reimbursements, and drug costs as key drivers of premium increases. Analyses of insurer filings indicate a median proposed increase of about 18 percent for ACA marketplace plans in 2026 [1].
• Possible expiration of premium tax credits.If the authorization of the premiums credit subsidies lapses, many enrollees will lose part of their subsidy, and net premiums could increase by 75 percent or more on average, depending on income and plan type [4].

Possible Offsetting Factors

The Centers for Medicare & Medicaid Services (CMS) has finalized a Marketplace Integrity and Affordability Rule to strengthen eligibility verification and reduce improper enrollments [5]. CMS estimates these new policies could lower individual-market premiums by about 5 percent on average [6].

Timeline

Open enrollment on the ACA Exchanges begins on November 1.  Ten states have already sent notices of new rates to Members who are currently enrolled on their exchanges, and every state will be providing notices by the start of Open Enrollment on November 1.  The new premium rates will go into  effect January 1, 2026 [1].

Steps Members Can Take

• Stay informed: Monitor your state insurance department announcements and AIA Trust updates this fall.
• Budget conservatively: Budget for higher costs in your 2026 budget
• Compare options early: Review multiple plans during open enrollment on HealthCare.gov or your state exchange.
• Use trusted advice and tools: Estimate potential changes using an on-line tool such as the KFF Premium Calculator [add cite].

AIA Trust Support

The AIA Trust continues to monitor ACA developments and evaluate how emerging changes may affect members. Additional information and context will be shared as appropriate through regular Trust communications.

Disclosure

All figures are based on publicly available insurer filings and independent analyses by KFF, CMS, and the Center on Budget and Policy Priorities. Projections and policy scenarios may change as states finalize rates and Congress determines the future of the enhanced premium tax credits.

References

[1] Kaiser Family Foundation (2025). How Much and Why ACA Marketplace Premiums Are Going Up in 2026. https://www.kff.org/affordable-care-act/issue-brief/how-much-and-why-aca-marketplace-premiums-are-going-up-in-2026/

[2] Kaiser Family Foundation (2025). How Much and Why Premiums Are Going Up for Small Businesses in 2026. https://www.kff.org/health-costs/how-much-and-why-premiums-are-going-up-for-small-businesses-in-2026/

[3] Kaiser Family Foundation (2025). Early Indications of the Impact of the Enhanced Premium Tax Credit Expiration on 2026 Marketplace Premiums. https://www.kff.org/affordable-care-act/issue-brief/early-indications-of-the-impact-of-the-enhanced-premium-tax-credit-expiration-on-2026-marketplace-premiums/

[4] Kaiser Family Foundation (2025). How Much More Would People Pay in Premiums if the ACA’s Enhanced Subsidies Expired? https://www.kff.org/interactive/how-much-more-would-people-pay-in-premiums-if-the-acas-enhanced-subsidies-expired/

[5] Centers for Medicare & Medicaid Services (2025). 2025 Marketplace Integrity and Affordability Final Rule. https://www.cms.gov/newsroom/fact-sheets/2025-marketplace-integrity-and-affordability-final-rule/

[6] Centers for Medicare & Medicaid Services (2025). CMS Finalizes Major Rule to Lower Individual Health Insurance Premiums for Americans. https://www.cms.gov/newsroom/press-releases/cms-finalizes-major-rule-lower-individual-health-insurance-premiums-americans/

[7] Mercer (2025). Employers prepare for the highest health benefit cost increase in 15 years. https://www.mercer.com/en-us/insights/us-health-news/employers-prepare-for-the-highest-health-benefit-cost-increase-in-15-years/