The ACA premium surge hits home
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The anticipated spike in Affordable Care Act premiums came into focus this week as previews of 2026 coverage options showed how customers could be on the hook for thousands more dollars in costs.
Why it matters: ACA open enrollment starts on Saturday, and people looking to re-up coverage could face both higher premiums and less assistance paying them if Congress doesn't extend enhanced pandemic-era subsidies.
- Republicans continue to rebuff Democrats' demands that an extension be part of a deal to reopen the government.
Where it stands: Insurers are raising the monthly premiums they charge for marketplace coverage by an average of 26% across the country, according to an analysis from KFF.
- Virginia's marketplace started sending renewal notices to residents outlining premium increases between 4% and 40%.
- Colorado announced this week that the cost of 2026 coverage sold on the state's marketplace will double compared with this year.
- Pennsylvania said premiums will increase an average of 21.5% next year.
Higher medical costs and rising prescription drug prices are driving up premiums, insurer trade group AHIP says.
Yes, but: The figures don't reflect what most people will actually pay for ACA coverage next year.
- Monthly premiums would surge an average of 114% if Congress allows enhanced tax credits to expire at the end of the year, KFF calculated.
- A Minnesota official said residents could owe $2,000 more in premium payments next year if the enhanced subsidies go away.
Congress originally passed the enhanced subsidies as a temporary pandemic measure. Under the policy, people making over 400% of the federal poverty level — $62,600 for an individual — do not have to pay more than 8.5% of their income toward marketplace health insurance.
Reality check: People earning between 100% and 400% of the federal poverty level will continue to get some of their premium subsidized next year, regardless of what Congress does.
- However, the COVID-era changes lowered premium costs for this group, meaning they'd also see higher costs next year if Congress doesn't act.
The Trump administration emphasized Wednesday that many consumers will have marketplace plan options with lower premiums than they did before the COVID-19 pandemic, even without enhanced subsidies.
- But the administration noted that average premiums next year after standard tax credits are applied would be $13 more per month than in 2025.
What we're watching: Budget and policy analysts predict that millions of people will decide coverage is beyond reach if enhanced subsidies aren't extended.
- Those presumed exits already are contributing to next year's higher premiums.
- Insurers said in state filings that they planned to charge about 4 percentage points higher on average based on the expectation that healthier people will drop coverage without enhanced subsidies, leaving a sicker pool of enrollees, according to KFF.
