As healthcare premiums rise, consumers might feel the pinch

ACA Individual Marketplace Premiums set to increase

KFF-Peterson Health System Tracker's estimate of a 15% median premium cost increase for ACA Marketplace plans is based on an assessment of 105 Marketplace insurers in 20 markets, including 19 states plus the District of Columbia.

That shakes out to 32 plans predicting a 10-15% increase in premiums. What's more, a quarter (27%) of plans included in the analysis predicted that their premiums will increase by 20% or more for 2026.

Usually, premium hikes are the result of the increased cost of medical care, sometimes referred to as medical trend.

"The costs of healthcare 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," the KFF-Peterson Health System Tracker authors said.

Some areas driving predicted health spend in 2026 include GLP-1 costs and a tight healthcare labor market.

Still, the 2026 medical trend is similar to last year's at 8%, the Peterson-KFF Health System Tracker revealed.

Instead, certain health policy factors will influence ACA Marketplace premiums.

For example, the enhanced tax credits are set to expire, which most of the insurers said in their rate filings will increase premiums by 4%. According to the Peterson-KFF Health System Tracker, marketplace insurers predict premiums for subsidized enrollees will spike by 75%, effectively pushing them off coverage and leaving a smaller and likely sicker risk pool. That will result in the overall 4% hike in premiums.

Policy issues like tariffs are also slated to make an impact, largely in terms of pharmaceutical cost. Of those insurers making public predictions on the matter, they said tariffs would likely spur an average 3% increase on premiums.

Employers slated to reduce healthcare benefits

Although employer-sponsored health insurance coverage is distinct from ACA Marketplace plans, the message is consistent: premiums are climbing and it's going to impact the consumer.

According to Mercer, employers can expect health insurance premiums to rise in 2026, albeit at a slower rate than for the ACA Marketplace plans.

"Employers project average health benefit costs to grow by nearly 6% this year, and 2026 may be even more challenging from a cost perspective,” Ed Lehman, Mercer's US Health & Benefits leader, said in a statement.

"While short-term cost containment actions might be needed to address current budget realities, we also see some employers using longer-term strategies, such as offering narrow network plans, that emphasize high-quality, high-value care," Lehman continued. "These strategies may improve health outcomes or make healthcare more affordable for employees."

While around half of employers are planning to shift more cost burden onto the consumer, either via higher deductibles or out-of-pocket maximums, others are looking at other cost containment strategies.

For example, about a third (35%) of employers said they will offer a non-traditional medical plan option in 2026. Such plans will seek to give employees "high-quality, more cost-efficient care," Mercer said.

Variable copay plans, which usually offer no or low deductibles and set copays based on individual provider fees, are one common strategy for this. These copays are often fixed and transparent, which creates the opportunity for patients to shop for care. Of the 6% of large employers currently offering fixed copay plans, 28% of covered employees chose to enroll in them in 2025.

Also on the horizon for employers is a stronger emphasis on mental healthcare. More than three-quarters of large employers will offer a digital stress management resource to employees in 2026. These resources might include a mindfulness and meditation app or an app designed to deliver cognitive behavioral therapy. Another half will offer in-person or live online resources for stress management, including individual and group coaching.

In addition, large employers are investing in managers to spot mental health needs among reports. Four in 10 large employers and 6 in 10 with more than 20,000 employees are offering this type of training to managers.

Sara Heath has covered news related to patient engagement and health equity since 2015.