How much and why ACA Marketplace premiums are going up in 2026 By Jared Ortaliza, Matt McGough, Kaitlyn Vu, Imani Telesford, Shameek Rakshit, Emma Wager , Lynne Cotter, and Cynthia Cox KFF August 6, 2025 Health insurers submitrate filings annually to state regulators detailing expectations and rate changes for Affordable Care Act(ACA)-regulated health plans forthe coming year. A relatively small, but growing, share ofthe population is enrolled in these plans (compared to the numberin employer plans), fueled by the availability of enhanced premium tax credits. This analysis focuses on individual market filings, which are generally more detailed and publicly available. These filings provide insightinto whatfactors insurers expect will drive health costs forthe coming year. For 2026, across 312 insurers participating in the ACA Marketplaces from the 50 states and the District of Columbia,this analysis shows a median proposed premium increase of 18%, which is about 11 percentage points higherthan last year. This is the largestrate change insurers have requested since 2018,the lasttime that policy uncertainty contributed to sharp premium increases. On average, ACA Marketplace insurers are raising premiums by about 20% in 2026. 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 marketfactors, such as increasing labor costs and inflation, as contributing to premium increases. In addition to rising healthcare costs,the majority of insurers are also taking into accountthe potential expiration of enhanced premium tax credits in their premium rate increases forthe next year. 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%, with insurers expecting healthier enrollees to drop coverage. That, in turn, increases underlying premiums. Otherfederal policy changes, like the implementation oftariffs and the ACA Marketplace Integrity and Affordability rule were also discussed,though to a lesser extent. ACA Marketplace insurers are proposing a median premium increase of about 18% in 2026 Distribution of proposed 2026 rate changes among 312 ACA Marketplace insurers Note: The median increase is about 18%. Source KFF analysis of data from ratereview.healthcare.gov, California Department of Managed Health Care and insurerrate filings Getthe data PNG 20 40 60 111 111 222 111 111999 999 444 444000 000 555 555888 888 666 666 666 333 333999 999 333 333000 000 111 111555 555 222 222222 222 111 111000 000 222 Less than -10% -10% to -5% -5% to 0% 0% to 5% 5% to 10% 10% to 15% 15% to 20% 20% to 25% 25% to 30% 30% to 35% 35% to 40% 40% to 45% 45% to 50% G • • Among the 312 ACA Marketplace participating insurers nationally, premium changes range from -10% to 59%, but most proposed premium changes for 2026 fall between about 12% and 27% (the 25th and 75th percentile,respectively). Ofthe 312 insurer filings, 4 insurers proposed decreasing premiums. Atthe other end ofthe spectrum, 125 insurers requested premium increases of atleast 20%. These filings are preliminary and may change during the rate review process. 2026 rates will be finalized in late summer. A table in the appendix shows proposed premium increases by state and insurer. There are a number of ways to assess premium changes in this market. In this analysis, a premium increase for a given insureris its enrollmentweighted average ofrate changes across all of its products within a state (i.e., bronze, silver, gold and platinum plans). These weighted average premium changes differfrom the percent change in the benchmark silver plan, which is the basis forfederal subsidies. In 2025,the median proposed rate increase was 7%, while the average increase in benchmark silver premiums was 4% in 2025. The vast majority of ACA Marketplace enrollees (92% in 2025)receive a subsidy and may not expectto face these premium increases depending on the plan they select. However,the potential expiration ofthe enhanced premium tax credits would decrease financial assistance across the board for all subsidized enrollees, leading to a more than 75% increase in average out-of-pocket premium payments. All else equal, premium increases generally resultin higherfederal spending on subsidies. What is driving 2026 premium changes? Figure 1 above shows premium changes for 312 insurers across all 50 states and DC. Forthe subsequent sections,this analysis focuses on a subset ofrate filings (105 insurers across 19 states and the District of Columbia),reviewed in more detailto better understand the factors driving premium changes in 2026. Across the 19 states and DC reviewed in this section, insurers have somewhatlower proposed rate increases, with a median of 15%. Rising healthcare costs Trend As in in most years,rising healthcare costs – both the price of care and increased use – are driving increasing rates. The costs of health care services like hospitalizations and physician care, as well as prescription drug costs tend to go up every year, and insurers often raise premiums to covertheir increased costs. For 2026, insurers commonly say the underlying cost of health care (medicaltrend) is similarto last year’s reported 8%. “The increasing cost of medical care is a significant driver ofthe rate change. This filing reflects the projected claims expenses increasing approximately 10% annually. About 7% ofthis increase is due to cost and utilization changes.” – Regence BlueCross Blue Shield of Oregon (Washington) “The underlying claim costs are expected to increase from 2024 to 2026,which is reflective of anticipated changes in the prices of medical services, the frequencywithwhich consumers utilize services, aswell as any changes in network contracts or provider payment mechanisms.” – Cigna HealthCare of Georgia, Inc. (Georgia) Inflation A small number of insurers have also cited general economic inflation as a driver of higher administrative and internal operating expenses. This inflationary environment places healthcare systems and providers underincreasing financial strain, which contributes to increases in premiums. “Blue Cross VT base administrative charges are increasing as compared to the 2025 approved rates, mostly due to inflationary pressures (see section 3.8.7), increasing premiums by 0.2 percentforindividuals and 0.4 percentfor small groups.” – Blue Cross Blue Shield of Vermont(Vermont) Labor costs, contracting, and provider consolidation A number of insurers also cite healthcare labor costs – driven by persistent clinical workforce shortages and broaderinflation – as a meaningful contributorto rising healthcare costs and 2026 premium increases. Providers are seeking higherreimbursementrates in negotiations, citing elevated staffing costs and continued post-pandemic financial difficulties, which insurers incorporate into theirtrend assumptions. “Like other payers, Moda is experiencing pressures on multiple fronts related to health careworkerlabor shortages. With providers experiencing postpandemic inflationary pressures,they are seeking increases that generally exceed previous years’requests.” – Moda Health Plan (Oregon) “Physicians and hospitals are facing economic pressures caused by supply chain shortages, overall inflation and continuedworkforce challenges. As a result, providers are seeking higherreimbursementfortheir services.” – Health New England, Inc. (Massachusetts) In a handful of filings, insurers also pointto provider consolidation,through hospital mergers and acquisitions, as contributing to higher contracted prices for services and reduced innovation due to increased provider market power. “Many systems are asking forlarge increases for services (some requesting and receiving double-digit annual increases) and have shown awillingness to allowour contracts to expire. Because ofthe limited competition and regional monopolies, some health care providers have achieved,there is reduced market pressure forthese systems to innovate new, more efficient practices.” – LifeWise Health Plan of Washington (Washington) GLP-1s and specialty medications Growing demand for GLP-1 drugs such as Ozempic and Wegovy is contributing to increased prescription drug spending. Insurers in the ACA Marketplace frequently apply utilization management policies like prior authorization and quantity limits to manage the high costs of GLP-1 drugs, which are used for diabetes treatment and weightloss. Several insurers pointto continued high utilization of GLP-1s (which gained popularity in recent years) as a driver of increased trend and premiums. “We expect utilization and script mix to increase by 18 percentin 2025 and seven percentin 2026. These trends are mostly driven by oncology and anti-diabetics, including significant growth inGLP-1 medications such as Ozempic.” – Kaiser Foundation Health Plan of Washington (Washington) “MVP has seen rapidly increasing utilization ofGlucagon-like peptide-1 (GLP-1) drugs throughout 2024. This is caused by rapidly increasing demand and has been exacerbated by supply shortages (themselves caused by thatincreased demand). Across all of MVP’s Vermont commercial population, total allowed costs forGLP-1 drugs (inclusive of both anti-diabetic and anti-obesity categories) have risen approximately 25-30% per quarterfor each quarter of 2024, and the 4th quarter of 2024 is nownearly double the total cost ofthe drugs in 2023.” – MVP of Vermont(Vermont) In response to the high costs ofthese medications, some insurers are beginning to remove coverage for GLP-1s for weightloss purposes, contributing to a decrease in premiums. This would impact some ofthe 45.8 million adults under 65 with private insurance, in both individual and employer plans, who are clinically eligible forthese drugs and are obese. “In 2024, fiveGLP-1 drugs accounted for over $300 million in spend.Drug makers’ prices forthese medications have led to an unsustainable increase in the cost of coverage for our members. In response, BCBSMA is affirming its commitmentto affordability and discontinuing coverage ofGLP-1 medications forweight-loss indications in 2026. This change has an effect ofreducing premium rates in 2026 by approximately 3% for our Merged Market members.” – Blue Cross Blue Shield of Massachusetts (Massachusetts) Beyond GLP-1s, other high-cost specialty drugs like biologics and gene therapies are also increasingly prevalent and are contributing to rising premiums in 2026. Some insurers explicitly cited specialty drugs as a key driver ofrising healthcare costs or pharmacy trends. These drugs and treatments are often characterized by high prices, a small number of users, and a lack of more affordable alternatives, all of which are placing mounting costs on both insurers and consumers. “High Rx costtrends are driven by the increased prevalence of specialty drugs in the market, newspecialty drugs expected to be introduced,the high cost per specialty prescription, and the lack of low-cost substitutes forthese drugs.” – BridgeSpan (Oregon) “Evenwith the exclusion of anti-obesityGLP-1 coverage,the pharmacy trend remains above double digits. This is largely due to a shiftin utilization toward brand-name and specialty drugs, including some newly approved high-cost cell and gene therapies.” – WellSense Health Plan (Massachusetts) “However,the savings trend associatedwith generics is being eclipsed by anothertrend around the rising cost and utilization of specialty medications including biologics…Specialty medications are used by approximately 2 percent of our members, butthey accountfor more than 50 percent oftotal drug spend.” – Excellus Health Plan, Inc. (New York) Tariffs Tariffs could potentially put upward pressure on the costs of pharmaceuticals and medical supplies, driving premiums upward in 2026. However, there is considerable uncertainty about how these trade policies will impact medical pricing, and insurers vary in how (orif)they factortariffs into theirrate development. A handful of insurers acknowledge the possibility of costincreases due to tariffs, but say they are not adjusting their 2026 rates atthis time. One insurer cites a lack of clear evidence and timing around implementation. “The 2026 individualrate filing does notinclude an adjustmentforthe impact of potentialtariffs. This is a dynamic situationwith proposed tariffs changing on an almost monthly basis. Therefore,we are not accounting for newtariffs untilthe situation becomes more stable.” – Kaiser Foundation Health Plan ofthe Northwest(Oregon) Otherinsurers are taking a more cautious approach by applying modest upward adjustments to theirtrend assumptions to hedge against potential costincreases, particularly in pharmaceutical manufacturing and distribution. On average, insurers that cite tariffs as a factor are raising premiums an additional 3 percentage points higherthan they would be withoutthese new tariffs. “Newtariffs on goods imported into the United States could have large impacts on medical cost and utilization trends; however,the anticipated impacts for 2026 are uncertain atthis time. This filing assumes the CPI-U released in Septemberwill be 0.5% higherthan the CPI-U released in April for purposes of developing facility costtrend factors. We also estimate a 3% increase to Pharmacy costtrends. There are no othertariff considerations factored into this filing.” – Blue Cross Blue Shield of Rhode Island (Rhode Island) Federal policy changes Expiration of enhanced premium tax credits Uncertainty overfederal policy changes has forced insurers to make some assumptions when developing theirrates for 2026. Commonly mentioned by insurers is the impact ofthe expiration of enhanced premium tax credits, which are scheduled to sunset atthe end of 2025, unless extended by Congress. The majority of insurers have assumed that enhanced tax credits will expire atthe end ofthis year, driving rates an average of 4 percentage points higherthan they otherwise would be. These increased rates are due to insurers anticipating that some healthier members will leave the ACA Marketplaces when their subsidies decrease, creating an enrollee base thatis less healthy and more expensive on average. “An adjustment of 1.044was applied to accountforthe expiration of enhanced premium subsidies passed under ARPA and extended by the Inflation Reduction Act(IRA).Due to the expiration ofthe enhanced premium subsidies effective 1/1/2026, UHC anticipates a decline in enrollment due to higher post-subsidy premiums.Healthier members are expected to leave at a disproportionately higherrate than thosewith significant healthcare needs, increasing market morbidity in 2026.” – Optimum Choice – United HealthCare (HMO) (Maryland) Uncertainty over whether enhanced tax credits will be available in 2026 has led some insurers to calculate rate increases for each scenario. In other states like Illinois, Maryland, Rhode Island and Washington, insurers submitted a second set ofrate filings that assumed the enhanced tax premium credits would be extended (which are notreflected in our analysis of average premium increases). For example, Neighborhood Health Plan of Rhode Island proposed a 16% increase in an alternate filing that assumes enhanced tax credits will continue, compared to a 21% rate increase in their primary filing. Regulators in other states, like Indiana and Michigan, did not mandate a complete set of alternate rates but stillrequested that insurers provide the rate impactif enhanced tax credits continue within the primary rate filings. In Connecticut, insurers were instructed by state regulators to file rates assuming that enhanced tax credits would continue. Even so, insurers in Connecticut still provided rate impactinformation forthe opposite scenario. “Anthem has included a 3.7% morbidity impactthatwill need to be applied to the rates in the event of enhanced subsidy expiration.” – Anthem Health Plans (Connecticut) 2025 Marketplace Integrity and Affordability Rule Some insurers also mention the ACA Marketplace Integrity and Affordability rule, which was initially proposed in March and finalized in June. Most insurers that estimate the ACA Marketplace Integrity and Affordability Rule’s impact on rate filings say it will have a small effect, if any. “On March 10, 2025,the Centers for Medicare & Medicaid Services (CMS) issued the “Marketplace Integrity and Affordability Proposed Rule”which revises standards in enrollment, including eligibility of enrollees and the timing of open enrollment periods. MVP has analyzed the rule and believes that these standardswill encourage lower-cost, healthier members to be more likely to forego coverage. Thiswill increase costs on the individual market as awhole. As a result, MVP has adjusted their marketwide index rate by a factor of 1.0025…” – MVP Health Plan, Inc. (New York) A small number of insurers expectthat provisions in the rule will push healthier enrollees out ofthe ACA Marketplaces, leading to a less healthy and higher-cost enrollee base. Otherinsurers noted the rule’s changes to the de minimis actuarial value (AV)thresholds, which could increase cost sharing for consumers, when developing theirrates. In Washington, insurers were specifically instructed notto accountforthe provisions ofthe then-proposed rule in theirrates. “An adjustment has been included to reflectthe anticipated impact ofthe proposed CMS Program Integrity Rules,which largely tighten the eligibility requirements for maintaining premium tax credits. These changes are expected to further magnify the enrollment deterioration beyond the impacts of premium tax credit expiration. Average morbidity ofthe individualrisk poolwilltherebyworsen due to the coverage lapses ofrelatively healthy individuals.” – Fidelis (New York Quality Healthcare Corporation) (New York) “Additionally,these rates assume that CMS’ Marketplace Integrity and Affordability rule, published in the Federal Register on March 19, 2025, is finalized as proposed – including key rule changes regarding open enrollment, special enrollment periods, and annual eligibility redeterminations. Rates also reflect benefit designs and cost-sharing structures alignedwith the revised de minimis actuarial value (AV)ranges specified in the proposed rule forthe 2026 plan year.” – Celtic Insurance Company (Illinois) The Republican budget reconciliation package The Republican budgetreconciliation legislation, formerly known as the “One Big Beautiful Bill,” was signed by President Trump in early July. Though the law itself was rarely mentioned by name in the insurerrate filings, some insurers made specific references to provisions in the legislation — namely,the potential funding for cost-sharing reductions. While funding for cost-sharing reductions was ultimately notincluded in the law, uncertainty led some insurers to calculate rate increases for both scenarios. “The estimated average change in rates thatwould be required if funding is provided for CSR payments is a decrease of 11.4% from the 2026 submitted rates. This adjustmentwould have no significant variation across plans and areas. The assumption change thatleads to the decrease in rates is the use of standard silver variant AVs for CSR membership to projectthe post-CSR payment plan paid liability, opposed to using the full CSR variant AVs forthis membership in the absence of CSR payments. Additionally,the statewide average premium was assumed to decrease by 9% percentwhich leads to a deterioration in ourrisk transfer estimate.” – Coordinated Care Corporation (Indiana) In Michigan, in particular, insurers were instructed to submit additionalrate filing documentation accounting forthe impact of funding for costsharing reductions. “As CMS has noted,there remains significant uncertainty regarding potential Congressional action orinaction, and multiple legislative outcomes could materially impact premium rates for Plan Year 2026. To address this uncertainty, UHC, as directed byDIFS, is submitting a set ofrates and associated assumptions thatreflect a scenario inwhich CSR payments are federally funded and enhanced premium tax credits under ARP and IRA expire.” – United Healthcare Community Plan (Michigan) A handful of filings also mentioned other policy changes (changes to the Federal Medical Assistance Percentage (FMAP) and end of Medicaid expansion)that could be related to reconciliation. While the majority of insurers did not mention the Republican budget package in theirrate filings this year, as provisions from the law begin to be implemented in the coming years,there is a potential foritto drive premiums upward. Other potential drivers of premium changes There are otherfactors not previously mentioned in this analysis that may play a role in premium changes. However,the following factors had little to no impact on premiums for 2026. COVID-19 More than two years afterthe end ofthe federal public health emergency, mostinsurers no longerfactor COVID-19 into theirrate filings. When COVID-19 is mentioned, insurers generally say there is no impact on their 2026 premiums. No Surprises Act Implemented in 2022,the No Surprises Act protects patients from unexpected bills for select out-of-network services by allowing them to pay innetwork cost-sharing rates. Ofthe reviewed insurerrate filings, none mentioned the No Surprises Act. Price transparency Both the Biden and Trump Administrations have taken steps to enhance healthcare price transparency, which could affect provider and insurer negotiations. However, insurers did not meaningfully mention any impact ofthese transparency measures on their 2026 premiums. Methods Proposed rates were collected from ratereview.healthcare.gov, California Department of Managed Health Care, and insurerrate filings for 312 insurers across 50 states and Washington, DC. Additionally, 105 insurer actuarial memoranda were collected from state rate review websites (orin the case of Georgia, provided directly by the state regulator) and were reviewed to understand the factors contributing to rate changes. These 105 insurers were from the following Marketplaces: Connecticut,the District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon, Rhode Island, Texas, Vermont, and Washington. Insurer actuarial memoranda were systematically evaluated for key words related to, but notlimited to, medicaltrend, COVID-19, Medicaid redeterminations, Inflation Reduction Act enhanced tax credits,tariffs,the ACA Marketplace Integrity and Affordability Rule, federal CSR funding, surprise billing, specialty medicine,telehealth, price transparency, market consolidation, and diabetes or weightloss drugs. Recorded medicaltrend values are annualized and do notinclude leveraging. Appendix Overall 2026 proposed rate change among ACA Marketplace plans, by insurer Note: Proposed rate changes are rounded to 1 decimal point. Source KFF analysis of data from ratereview.healthcare.gov, California Department of Managed Health Care and insurerrate filings Getthe data PNG Search in table Page 1 of 16 State Company Requested Rate Change Alabama Blue Cross and Blue Shield of Alabama 19.3% Alabama Celtic Insurance Company 29.0% Alabama UnitedHealthcare Insurance Company 20.0% Alaska Moda Health Plan, Inc 5.3% Alaska Premera Blue Cross Blue Shield of Alaska −0.8% Arizona Antidote Health Plan of Arizona 0.3% Arizona Arizona Complete Health 49.0% Arizona Blue Cross Blue Shield of Arizona, Inc. 29.9% Arizona Cigna HealthCare of Arizona, Inc. 33.0% Arizona Imperial Insurance Companies Inc. 9.6% Arizona Oscar Health Plan, Inc. 16.6% Arizona UnitedHealthcare of Arizona, Inc. 43.7% Arkansas Celtic Insurance Company 42.5% Arkansas HMO Partners, Inc. d/b/a Health Advantage 52.3% Arkansas QCA Health Plan, Inc. 54.2% Arkansas QualChoice Life and Health Isurance Company, Inc. 54.4% Arkansas USAble HMO, Inc. d/b/a Octave 55.1% Arkansas USAble Mutual Insurance Company 58.9% California California Physicians' Service (Blue Shield of California) 8.0% California Kaiser Foundation Health Plan, Inc. (Kaiser Permanente) 7.0% • • © 2025 PETERSON-KFF Health System Tracker All Rights Reserved