ACA premium surge hits home for Hoosiers
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The anticipated spike in Affordable Care Act premiums is now reality, putting customers shopping for 2026 coverage plans on the hook for thousands more dollars annually.
Why it matters: ACA open enrollment started Saturday, and people looking to re-up coverage are facing both higher premiums and less assistance paying them, as Congress still hasn't extended enhanced pandemic-era subsidies.
The latest: The tentative deal reached in the Senate on Sunday night includes a December vote on a Democratic proposal to extend ACA tax credits for one year, multiple sources said. It would take 60 votes to pass.
The big picture: 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.
- 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.
Zoom in: More than 350,000 Hoosiers bought insurance through the ACA exchange last year.
- About 9-in-10 of them received a subsidy, according to federal data.
- On average, those subsidies lowered premiums by more than $400 per month.
What they're saying: "If they go up any higher, I'm going to have to get another job," said Kendra Bush, a home health worker in northwest Indiana. "I have two now. I'm going to need three."
- Bush said her premiums will increase from $20/month to $400/month without subsidies.
Between the lines: 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 premiums 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.
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.