ACA Insurance Rates Statistics in US 2026 | Key Facts

ACA Insurance Rates in the US 2026

The Affordable Care Act marketplace is experiencing unprecedented upheaval in 2026, with insurance premiums surging to the highest levels since the exchanges launched in 2014. According to comprehensive analyses by KFF, MoneyGeek, and other health policy organizations, ACA marketplace premiums are increasing by an average of 26% in 2026, marking the steepest year-over-year jump since 2018. This dramatic increase affects the 24.2 million Americans who enrolled in marketplace coverage for 2025, representing more than double the 11.4 million who were enrolled just five years ago in 2020. The rate hikes vary dramatically by region, with some states experiencing increases exceeding 60-67% while others see more modest single-digit growth. States using the federal Healthcare.gov platform face an average 30% premium increase, while states running their own marketplaces see a comparatively lower 17% average increase.

The crisis in ACA insurance rates in the US 2026 stems from multiple converging factors creating what health policy experts describe as a “perfect storm” for affordability. Rising healthcare costs driven by hospital price increases averaging 6-8% annually, skyrocketing demand for expensive GLP-1 weight-loss drugs like Ozempic and Wegovy, potential drug tariffs, and inflation-driven labor costs all contribute approximately 22 percentage points to the premium surge. However, the most consequential driver is the expiration of enhanced premium tax credits on December 31, 2025—a policy cliff that insurers factored into their 2026 rates by adding an average 4 additional percentage points to premiums based on expectations that healthier enrollees would drop coverage. With Congress failing to extend the subsidies before year-end, KFF estimates that average out-of-pocket premium payments will more than double, rising 114% from $888 in 2025 to $1,904 in 2026 for the typical subsidized enrollee. A 60-year-old couple making $85,000 annually could see their yearly premium payments skyrocket by over $22,600, bringing their total cost to approximately 25% of their annual income. The ACA insurance rate statistics in US 2026 reveal that this affordability crisis threatens to unravel a decade of coverage gains, with the Congressional Budget Office projecting 4.2 million additional uninsured Americans over the next decade if enhanced subsidies remain expired.

Key Interesting Facts About ACA Insurance Rates in the US 2026

Data Sources: KFF Health System Tracker October-November 2025, Centers for Medicare & Medicaid Services 2025, Peterson-KFF Health System Tracker August 2025, MoneyGeek Analysis November 2025, Center on Budget and Policy Priorities November 2025

The statistics above illustrate the magnitude of the ACA insurance rate crisis in the US 2026. The 26% average premium increase represents the largest year-over-year jump since 2018, when similar policy uncertainty around the individual mandate repeal drove premiums sharply higher. The variation between Healthcare.gov states (30% average) and state-run marketplaces (17% average) underscores how state-level policies including reinsurance programs, Medicaid expansion, and active market management can moderate rate increases. The range from negative 10% to positive 67% demonstrates extraordinary geographic disparities, with some localities experiencing premium decreases while others face catastrophic increases that could price out entire segments of the population.

The enrollment and subsidy data reveal the stakes of the affordability crisis. With 24.2 million Americans enrolled for 2025—more than double the 11.4 million in 2020—the marketplace has achieved record participation largely due to enhanced premium tax credits that made coverage affordable for middle-income families. The fact that 93% of enrollees (22 million people) receive subsidies underscores how dependent the market has become on federal financial assistance. The projected 114% increase in out-of-pocket costs from $888 to $1,904 annually for the average subsidized enrollee translates to $1,016 more per year—a burden that KFF’s own survey research suggests nearly 60% of marketplace enrollees cannot afford if costs increase by even $300 annually. For older enrollees and those with incomes above 400% of poverty (approximately 10% of marketplace participants), the impact is exponentially worse, with some facing annual increases exceeding $20,000. The ACA insurance rate statistics in the US 2026 demonstrate that without congressional action to restore enhanced subsidies, the marketplace faces potential destabilization as healthy enrollees drop coverage, further driving adverse selection and creating the insurance “death spiral” that health policy experts have long warned against.

Premium Increases by State in the US 2026

Data Source: MoneyGeek State Analysis November 2025, KFF State Marketplace Data October 2025, StretchDollar Metro Analysis 2025

The geographic variation in ACA insurance rate increases in the US 2026 reveals extreme disparities that make zip code the single strongest predictor of what Americans will pay for health coverage. Arkansas leads the nation with a staggering 67% average premium increase, followed by Kansas where residents in Wichita face Gold plan increases of 68.3% (from $451 to $759 monthly) and Bronze plan increases of 45%. Rhode Island, West Virginia, Wyoming, Mississippi, South Carolina, and Alabama all experience increases exceeding 35%, placing enormous financial strain on enrollees in these states. The concentration of the highest increases in states using the federal Healthcare.gov platform and states that have not expanded Medicaid is not coincidental—eight of the nine non-expansion states saw above-average premium growth, and states relying solely on the federal exchange lack the state-level market interventions that can moderate rate volatility.

Conversely, states with state-run marketplaces, Medicaid expansion, and reinsurance programs demonstrate substantially more stable premium environments. Minnesota experienced essentially flat premiums with 0-2% increases, while New York saw only 3% increases, Vermont 5%, Massachusetts 6%, and California 9%—all well below the national average. These states share common characteristics: they operate their own exchanges allowing active market management, have expanded Medicaid reducing the number of high-risk individuals in marketplace pools, and in some cases (Minnesota, New York) operate Basic Health Programs that cover low-income individuals who would otherwise destabilize marketplace risk pools. MoneyGeek’s analysis found that states combining all three policy protections (Medicaid expansion, reinsurance, and state-run marketplace) reported average increases in the low-teens range, compared to high-twenties or thirties in states lacking these interventions. The ACA insurance rate statistics in the US 2026 demonstrate that state policy choices have measurable, significant impacts on premium affordability, with some states effectively shielding their residents from the worst of the national rate crisis while others leave enrollees fully exposed to market volatility.

Impact of Enhanced Premium Tax Credit Expiration in the US 2026

Data Source: KFF Premium Calculator October 2025, Center on Budget and Policy Priorities November 2025, KFF Analysis September 2025

The expiration of enhanced premium tax credits on December 31, 2025 represents a policy cliff with catastrophic financial consequences for millions of ACA marketplace enrollees in the US 2026. The enhanced subsidies, first enacted in the American Rescue Plan Act of 2021 and extended through 2025 by the Inflation Reduction Act of 2022, fundamentally restructured marketplace affordability by capping premium contributions at no more than 8.5% of income for all enrollees (eliminating the previous 400% federal poverty level eligibility cutoff) and reducing contribution percentages on a sliding scale for lower-income enrollees. Under the enhanced credits, an individual making $28,000 (204% FPL) paid approximately 1% of income ($325 annually) for benchmark silver coverage. Without the enhancements, this same individual will pay nearly 6% of income ($1,562 annually)—a $1,238 annual increase representing nearly 380% growth.

The impacts are even more severe for older enrollees and those with incomes above the former 400% FPL subsidy cliff. A 60-year-old couple making $85,000 (402% of poverty) qualified for enhanced subsidies capping their premiums at 8.5% of income (approximately $7,225 annually or $602 monthly). Without enhancements, they lose subsidy eligibility entirely and face the full unsubsidized premium—which after the 18% rate increase and 26% average hike could reach approximately $31,000 annually ($2,583 monthly), an increase of over $22,600 representing approximately 25% of their total household income. Lower-income enrollees see particularly harsh percentage increases from current near-zero premiums. An individual at 140% FPL ($22,000) who paid $0 for a benchmark silver plan in 2025 now faces $66 monthly ($786 annually), while a 45-year-old at 128% FPL in a non-Medicaid expansion state sees premiums jump from $0 to $420 annually. The ACA insurance rate statistics in the US 2026 reveal that approximately 45% of marketplace enrollees have incomes between 100-150% of poverty and will experience the largest percentage increases, while the 10% with incomes above 400% FPL face the largest absolute dollar increases, creating affordability crises across the entire income spectrum.

Enrollment Trends and Projected Coverage Losses in the US 2026

Data Source: CMS Marketplace Reports 2020-2025, KFF Enrollment Analysis September 2025, Congressional Budget Office Estimates 2025

The enrollment trends in ACA marketplaces in the US 2026 reflect a decade of dramatic growth driven primarily by enhanced premium tax credits, which now faces potential reversal as affordability deteriorates. From 2020 to 2025, marketplace enrollment more than doubled from 11.4 million to 24.2 million (+113%), with nearly 13 million additional Americans gaining coverage. The 2025 open enrollment period alone brought 3.9 million new consumers—nearly double the approximately 2 million new enrollees annually in earlier years—while 20.3 million returning or auto-enrolled individuals demonstrated strong retention. State-based marketplaces showed particularly robust growth, increasing 142% (+4.4 million) compared to 101% growth on Healthcare.gov, reflecting more stable state-level policy environments and active outreach.

However, the Congressional Budget Office projects that subsidy expiration will reverse these gains, with 4.2 million additional uninsured Americans over the next decade compared to a scenario where enhanced credits continue. More immediately, CBO estimates that if Congress had extended subsidies earlier rather than waiting until year-end (which ultimately did not happen), 1.5 million fewer people would be uninsured in 2026—suggesting that delayed or failed congressional action has already driven substantial coverage losses during the 2026 open enrollment period as enrollees saw projected premium increases and chose not to enroll. The geographic and demographic composition of enrollment losses is particularly concerning: 88% of enrollment growth since 2020 (11.4 million of 12.9 million new enrollees) occurred in states won by President Trump in the 2024 election, with states like Texas (+255%, from 400K to 1.42M), Mississippi (+242%), Georgia (+227%), and Tennessee (+221%) seeing the largest percentage gains. These states—predominantly non-Medicaid expansion states with high uninsured rates—are most vulnerable to coverage losses. The ACA insurance rate statistics in the US 2026 suggest that the marketplace may experience its first year-over-year enrollment decline since the enhanced subsidies were implemented, potentially triggering the adverse selection “death spiral” as healthier enrollees drop coverage and sicker enrollees remain, further driving future premium increases.

Cost Drivers Behind Premium Increases in the US 2026

Data Source: Peterson-KFF Health System Tracker August 2025, Insurer Rate Filings to State Regulators 2025, KFF Analysis October 2025

The 26% average premium increase in ACA marketplaces in the US 2026 stems from multiple converging cost pressures that insurers detailed in their rate filings to state regulators. Hospital cost increases emerge as the single largest driver, contributing an estimated 6-8 percentage points to premium growth. Insurers consistently cited hospital price escalation outpacing general inflation, with some reporting year-over-year provider contract rate increases of 7-10%. This reflects broader trends in healthcare consolidation that give hospital systems greater market power to demand higher reimbursement rates, costs that insurers pass directly to consumers through premium increases. Labor cost inflation adds another 2-4 percentage points, as healthcare worker shortages—particularly for nurses and specialized technicians—drive wage increases that hospitals and other providers incorporate into their pricing.

The explosive growth in GLP-1 drug utilization for weight loss and diabetes management represents a relatively new and substantial cost driver, contributing an estimated 3-5 percentage points to premium increases. Medications like Ozempic, Wegovy, Mounjaro, and Zepbound carry list prices of $900-$1,350 monthly ($10,800-$16,200 annually), and their rapid adoption—with millions of Americans now using these drugs—creates enormous cost pressures for insurers. Unlike traditional specialty drugs used by small patient populations, GLP-1s have mainstream appeal for weight management, potentially affecting 10-20% of the insured population. High-cost specialty pharmaceuticals more generally add 2-3 percentage points, including biologics for cancer, autoimmune diseases, and rare conditions. Potential drug tariffs contribute 1-2 percentage points through policy uncertainty, as insurers factor possible import cost increases into their rate projections. Most concerning is the 4 percentage point increase insurers added specifically because they expect healthier enrollees to drop coverage when enhanced subsidies expire—a self-fulfilling prophecy that could trigger ongoing adverse selection. The ACA insurance rate statistics in the US 2026 demonstrate that while healthcare cost growth drives the majority of premium increases, policy uncertainty and subsidy expiration compound the affordability crisis by layering additional costs onto an already strained system.

State Policy Interventions and Premium Stability in the US 2026

Data Source: MoneyGeek State Policy Analysis November 2025, KFF State Marketplace Tracker 2025, Peterson-KFF August 2025, State Insurance Department Reports 2025

The correlation between state policy interventions and premium stability in ACA marketplaces in the US 2026 demonstrates that state-level actions can significantly moderate rate increases and protect consumers from the worst market volatility. State-run marketplaces (SBMs) show average premium increases of 17% compared to 30% in Healthcare.gov states—a 13 percentage point difference. This disparity reflects several mechanisms: SBMs can actively manage plan offerings and standardize benefits, negotiate with insurers for competitive rates, implement targeted outreach to attract healthier enrollees, and quickly respond to market disruptions. States like Massachusetts (6% increase), Vermont (5%), Minnesota (0-2%), and New York (3%) all operate SBMs and demonstrate exceptional premium stability.

Medicaid expansion correlates with 5-8 percentage point lower premium increases by removing the sickest, lowest-income individuals from marketplace risk pools and providing them coverage through Medicaid instead. Eight of nine non-expansion states (Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wyoming) experienced above-average premium growth, while expansion states cluster toward lower increases. Reinsurance programs—where states fund payments to insurers covering high-cost claims—reduce premiums by an estimated 5-10 percentage points in the 16 states operating them. States combining all three policies (state-run marketplace, Medicaid expansion, and reinsurance) achieve the lowest and most stable premiums nationally, with increases typically in the low-teens range (12-18%). In response to federal subsidy expiration, eight states (California, Colorado, Massachusetts, Maryland, New Jersey, New Mexico, Vermont, Washington) announced state-funded subsidy programs to partially or fully backfill federal assistance, shielding their residents from the worst premium impacts. The ACA insurance rate statistics in the US 2026 demonstrate that while federal policy creates the baseline market structure, state interventions can determine whether premiums remain affordable or spiral beyond reach for middle-class families.

Demographics and Income Distribution of Marketplace Enrollees in the US 2026

Age Distribution of Marketplace Enrollees:

Data Source: KFF Analysis September 2025, CMS Marketplace Demographic Data 2024-2025, Center on Budget and Policy Priorities November 2025

The demographic and income composition of ACA marketplace enrollees in the US 2026 reveals which populations face the greatest risk from premium increases and subsidy expiration. Forty-five percent of enrollees (approximately 10.9 million people) have incomes between 100-150% of the federal poverty level ($15,060-$22,590 for individuals, $31,200-$46,800 for families of four). Under enhanced subsidies, these individuals paid 0-2% of their income for benchmark coverage—often qualifying for zero-premium silver plans with cost-sharing reductions. Without enhancements, they face premiums of 3-6% of income, translating to annual increases of $400-$1,500 that represent devastating proportions of limited budgets. The next 28% of enrollees (6.7 million people) with incomes between 150-250% FPL experience similarly harsh percentage increases as their premiums jump from 2-6% of income to 5-9% of income.

The 10% of enrollees (approximately 2.4 million) with incomes above 400% FPL face the most severe absolute dollar increases. These individuals—often early retirees aged 55-64, self-employed professionals, or small business owners—qualified for enhanced subsidies capping premiums at 8.5% of income but now lose subsidy eligibility entirely and must pay full unsubsidized premiums. For a 60-year-old couple at 402% FPL ($85,000), this means a jump from approximately $7,200 annually to potentially $30,000+—an increase of over $22,000. Age distribution compounds these challenges: approximately 30% of marketplace enrollees are ages 55-64 (7.3 million people), the demographic facing both the highest premium rates (due to age-based pricing) and often fixed incomes from early retirement or self-employment. Conversely, 25% are ages 18-34 (6 million), the healthy younger enrollees most likely to drop coverage when premiums spike, accelerating adverse selection. The ACA insurance rate statistics in the US 2026 demonstrate that the affordability crisis cuts across income levels and age groups, with lower-income enrollees facing the largest percentage increases, higher-income enrollees facing the largest dollar increases, and older enrollees facing a “double whammy” of both high baseline premiums and steep subsidy cuts.

Geographic Variation: Metro Areas with Largest Increases in the US 2026

Data Source: StretchDollar Metro Area Analysis 2025, MoneyGeek State Data November 2025, KFF State Premium Tracker October 2025

The geographic variation in ACA insurance premium increases across major metropolitan areas in the US 2026 demonstrates that urban residents face dramatically different cost environments based on state and local market dynamics. Wichita, Kansas experiences the most severe metro-area premium shock, with Gold plan premiums surging 68.3% from $451 to $759 monthly ($5,412 to $9,108 annually)—an increase of $3,696 per year for unsubsidized enrollees. Bronze plan premiums in Wichita increased 45% from $451 to $655, demonstrating that even “catastrophic” coverage options experience substantial cost growth. Providence, Rhode Island sees Gold plan increases of 41% (from $369 to $521 monthly) and Bronze increases of 28%, with state regulators noting these are the highest rate increases in over a decade for Rhode Island.

Southern metro areas including Little Rock, Arkansas and Jackson, Mississippi face estimated increases exceeding 35-60%, pricing out thousands of unsubsidized enrollees and forcing difficult coverage decisions for subsidized consumers. Conversely, metro areas in states with comprehensive market protections demonstrate remarkable stability. San Francisco experiences only 9% increases aligned with California’s state average, Boston sees 6% growth matching Massachusetts’s low rates, and New York City’s 3% increase (on already-high baseline premiums reflecting New York’s community rating system) represents minimal affordability disruption. The metro-level data also reveals that some high-cost states like Vermont maintain stability despite elevated baseline premiums—Vermont’s $1,223 monthly premium for a 40-year-old represents 50% higher costs than Arkansas despite Arkansas experiencing a 67% increase. The ACA insurance rate statistics in the US 2026 illustrate that for urban Americans, city of residence determines whether health insurance remains affordable or becomes financially devastating, with residents of states lacking market protections facing the harshest consequences.

Insurer Participation and Market Competition in the US 2026

Major Insurer Changes for 2026:

Data Source: Peterson-KFF Analysis August 2025, Urban Institute Study October 2025, CMS Marketplace Data 2020-2026

The insurer participation trends in ACA marketplaces in the US 2026 reveal concerning signs of market instability driven by policy uncertainty and deteriorating risk pools. After years of steady growth from approximately 280 insurers in 2020 to 333 in 2025, participation declined to 312 active insurers for 2026—a net loss of 21 carriers. The average number of insurers per state decreased from 4.5 to 4.2, and the number of states with five or more competing insurers fell from 22 to 18. Most dramatically, 21 states experienced a reduction in the number of participating insurers, signaling that carriers are retreating from markets they perceive as unstable or unprofitable.

Aetna’s complete exit from ACA marketplaces after 2025 represents the most significant carrier withdrawal, affecting approximately 1 million enrollees across 17 states including Maryland, Virginia, Pennsylvania, and Florida. The insurer cited “significant uncertainty about federal ACA policy” and expectations that the market would deteriorate without enhanced subsidies, making continued participation financially untenable. UnitedHealthcare, the nation’s largest health insurer, has implemented significant premium increases while factoring in expectations that healthier members will drop coverage, as evidenced in rate filings where the company stated it applied “an adjustment of 1.044 to account for the expiration of enhanced premium subsidies… [because] healthier members are expected to leave at a disproportionately higher rate.” Conversely, regional insurers including Ambetter (Centene), Oscar Health, Molina Healthcare, and Kaiser Permanente have expanded or maintained presence while offering premiums 10-20% lower than legacy national carriers, though their combined market share remains smaller. The ACA insurance rate statistics in the US 2026 demonstrate that reduced competition—particularly the exit of major carriers—removes downward pressure on premiums and increases the risk of monopoly or duopoly markets in certain states where remaining insurers can charge higher rates without competitive discipline.

Impact on Small Businesses and ICHRA Strategies in the US 2026

Data Source: StretchDollar ICHRA Analysis 2025, National Business Group on Health 2026 Projections, Benefit Consultants Reports 2025

The impact of ACA insurance rate increases on small business strategies in the US 2026 creates difficult choices for employers seeking to provide affordable coverage. Traditional small group plans (businesses with 2-50 employees) face relatively modest increases of 6-7% in 2026, significantly lower than the 20-67% range in individual marketplace plans. This growing divergence makes conventional small group coverage increasingly attractive compared to Individual Coverage Health Reimbursement Arrangements (ICHRAs), which reimburse employees for individual marketplace premiums. While ICHRAs offered flexibility and potential cost savings in prior years—particularly when enhanced subsidies made marketplace plans highly affordable—the 2026 premium surge undermines this model for many businesses.

For businesses with employees who qualify for premium tax credits (generally those earning under $60,000-$70,000 for individuals), ICHRAs remain viable as subsidies absorb much of the premium increase. However, for businesses with higher-earning employees or those above subsidy thresholds, the 20-67% marketplace premium increases translate directly to employer reimbursement costs. Some small businesses are pivoting to off-exchange plans offered directly by insurers, which sometimes feature 8-10% increases (lower than on-exchange but without subsidy eligibility) and may provide better value for non-subsidized employees. Others are exploring association health plans (AHPs) that allow industry groups to pool purchasing power, though these remain controversial due to less stringent coverage requirements. The ACA insurance rate statistics in the US 2026 reveal that small businesses face a strategic inflection point: pay significantly more for ICHRA reimbursements, absorb higher small group premiums, or risk leaving employees uninsured or underinsured—with no clearly optimal solution in the current market environment.

Congressional Action and Future Outlook for ACA Rates in the US 2026

State-Level Subsidy Programs Announced for 2026:

Data Source: Congressional Budget Office Estimates 2025, KFF Policy Analysis October 2025, State Insurance Commissioners Reports 2025, Center on Budget and Policy Priorities November 2025

The future outlook for ACA insurance rates in the US 2026 hinges entirely on congressional action regarding enhanced premium tax credits, with the policy cliff on December 31, 2025 representing a make-or-break moment for marketplace stability. The Congressional Budget Office projects that if enhanced subsidies expire permanently, 4.2 million additional Americans will become uninsured over the next decade, with 1.5 million losing coverage immediately in 2026 due to the delayed timing of any potential extension. The federal government would “save” approximately $335 billion over ten years by allowing expiration, though these savings come at the cost of massive coverage losses, deteriorating risk pools, and potential marketplace collapse in certain states.

Congressional options range from permanent extension (restoring market stability but costing ~$335 billion), to one-year extension (providing temporary relief at ~$30 billion but requiring annual renewal fights), to partial extension limiting enhanced subsidies to lower income levels (compromising between coverage and cost at ~$150-200 billion). In the absence of federal action, eight states (California, Colorado, Massachusetts, Maryland, New Jersey, New Mexico, Vermont, Washington) have announced state-funded subsidy programs totaling over $1.3 billion annually to partially backfill federal assistance. California alone committed approximately $500 million yearly to maintain affordability for residents with incomes above 400% FPL. However, these state programs are limited in scope, cannot fully replace federal subsidies, and are unavailable to residents of the 42 other states that lack fiscal capacity or political will to intervene. The ACA insurance rate statistics in the US 2026 suggest that without federal extension, the marketplace will likely experience its first year-over-year enrollment decline since enhanced subsidies began, triggering adverse selection dynamics that could lead to further premium increases of 20-30% in 2027 as healthier enrollees drop coverage and sicker individuals remain, creating the “death spiral” scenario that has haunted the marketplaces since their 2014 inception.

Disclaimer: This research report is compiled from publicly available sources. While reasonable efforts have been made to ensure accuracy, no representation or warranty, express or implied, is given as to the completeness or reliability of the information. We accept no liability for any errors, omissions, losses, or damages of any kind arising from the use of this report.

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