Authored by Wesley Brown

The nation’s health-care marketplace insurers are seeking the largest premium increases in more than five years, ahead of the upcoming Affordable Care Act (ACA) enrollment period in November, according to an analysis by the Peterson Center on Healthcare and health policy nonprofit KFF.

The July 18 report highlights several factors driving up insurance rates for 2026, as major health insurers submit rate filings to state regulators to justify premium changes for the upcoming calendar year.

“As in most years, rising healthcare costs—both the price of care and increased use—are a significant driver for increasing rates going into plan year 2026. 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 report states.

The Peterson–KFF analysis examined insurers in the District of Columbia and 19 states: Connecticut, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon, Rhode Island, Texas, Vermont, and Washington.

Finalized 2026 rate changes are expected to be published in late summer, and individuals will be able to see how their plans’ premiums are changing just before open enrollment begins in November.

The report states that heading into 2026, insurers expect that some policy changes will drive up their costs, increasing premiums beyond what they would otherwise be. Among these changes are enhanced ACA premium tax credits, which make coverage more affordable and will expire at the end of 2025, resulting in an average increase of more than 75 percent in out-of-pocket premium payments. The impact will vary depending on income and family composition.

“This is expected to cause healthier enrollees to drop their coverage and create a sicker risk pool,” the report states.

An earlier Peterson–KFF analysis found that the expiration of enhanced premium tax credits increased proposed rates by an average of 4 percent. It also stated that there would be gross premium increases, as healthier people are expected to drop their coverage in larger numbers due to increases in their net premium payments.

“Unless the premium tax credits are extended, consumers can expect increases in both the net premium payments and gross premiums,” the June 3 report states.

The Congressional Budget Office projects that, on average, gross benchmark silver premiums will ultimately be 7.9 percent higher than they would otherwise be as the risk pool becomes sicker, on average, and that many enrollees will become uninsured.

Tariffs could also drive up the cost of certain drugs, medical equipment, and supplies, the July 18 report stated. It further notes that some insurers report that tariffs—and the uncertainty surrounding them—are causing rate increases.

A June 18 KFF report stated that Optimum Choice of Maryland, Independent Health Benefits Corporation of New York, and UnitedHealthcare of New York are increasing premiums by 2.4 percent, 2.9 percent, and 3.6 percent, respectively, due to the impact of tariffs on pharmaceuticals.

Many insurers submitted proposed rates before Congress passed the budget reconciliation legislation and the Centers for Medicare and Medicaid Services finalized its rule on marketplace integrity and affordability. The legislation and new Medicaid rule, which explain how the ACA marketplace operates and how individuals enroll, were only finalized recently, and it is still unclear how insurers might respond, the report states.

“Early indications are that individual market insurers will be increasing premiums in 2026 by more than they have since 2018, the last time policy uncertainty contributed to sharp premium increases,” the July 18 Peterson–KFF report states. It noted that premiums are increasing by a median of 15 percent across the 20 markets it analyzed.

Another factor creating uncertainty in the rate filing process is the implementation of the Trump administration’s ACA integrity rule. Based on what insurers have filed so far, this does not generally appear to be driving rate changes in either direction, according to the report.

“Insurers and state regulators are still finalizing rates for the upcoming plan year, so these filed premium increases may change,” it states.