Health Insurance Marketplace premiums to grow 18%: KFF

A new analysis from the Peterson Center on Healthcare and KFF finds Health Insurance Marketplace premiums will grow by about 11 percentage points in 2026, resulting in a median proposed increase of 18%.

Researchers analyzed individual market filings containing publicly available information on what payers expect to drive their healthcare costs in the coming year. They studied over 300 payers participating in the Affordable Care Act's Health Insurance Marketplace across 50 states and the District of Columbia.

The analysis revealed the largest proposed rate change proposed by participating payers since 2018, which researchers pointed out was the "last time that policy uncertainty contributed to sharp premium increases."

Some payers do expect to reduce premiums by as much as 10%, however, most proposed premium changes for 2026 were between 12% and 27%, the analysis found. Although, premium changes could be as high as 59%, according to the payer filings.

Prices primarily contributed to the requested premium hikes, with payers citing increasing costs and utilization of expensive prescription drugs like GLP-1s, biologics and gene therapies.

Rising prescription drug costs are contributing to other premium increases. Last week, CMS released data on premium amounts for Medicare Part D plans, which cover prescription drugs for Medicare beneficiaries supplementing traditional coverage. Payers expect to increase premiums for Part D plans, with the average national monthly bid increasing by 33% to $239.27 in 2026.

Researchers also said general market factors, including higher labor costs and inflation, contributed. Providers continue to ask for higher reimbursement rates in negotiations as a result of higher staffing costs and ongoing financial difficulties following the COVID-19 pandemic. Provider consolidation also prompted higher reimbursement rates during negotiations, researchers explained.

Most payers included in the analysis also accounted for the potential expiration of enhanced premium tax credits, which have driven enrollment in the Health Insurance Marketplace since the pandemic.

The enhanced credits, as implemented through the American Rescue Plan Act of 2021, expanded eligibility for Marketplace plan enrollment to middle-income populations and increased the level of financial assistance available for enrollment in the plans. The Inflation Reduction Act later extended the premium credits through the end of 2025.

Since introducing the premium credits, enrollment in the Health Insurance Marketplace has more than doubled from 11.4 million people in 2020 to 24.3 million people in 2025, KFF previously reported. Most enrollees receive some tax credit to lower their monthly payment for insurance.

Payers anticipate healthier enrollees to drop Health Insurance Marketplace coverage if Congress does not extend the enhanced credits, prompting payers to increase premiums to account for a sicker enrollee population.

In some states, including Illinois, Maryland, Rhode Island and Washington, payers even submitted a second set of rate filings in the event the enhanced credits are extended. These filings generally had lower proposed premium increases, with one insurer in Rhode Island proposing a 16% hike versus a 21% increase in the primary filing.

Researchers also found that payers pointed to President Trump's tariffs and the ACA Marketplace Integrity and Affordability rule as reasons for proposed premium increases, although to a lesser extent than prices and other market factors.

The ACA Marketplace Integrity and Affordability rule finalized by the Trump Administration in June aims to reduce healthcare fraud, waste and abuse by addressing improper enrollments. Among the policy changes in the rule, more rigorous income and eligibility verifications are required for Health Insurance Marketplace enrollment.

Payers expect to finalize their 2026 rates by late summer.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.