Escalating ACA Premiums: What to Expect as Open Enrollment Nears
As open enrollment approaches, consumers in the Affordable Care Act (ACA) marketplace are bracing themselves. Soon, notices—whether digital or paper—will begin arriving in mailboxes, alerting individuals and families to their plan options, monthly premiums, and expected out-of-pocket expenses. Stirring particular concern: proposed rate increases far steeper than what we've seen in recent years.
1. Marketwide Premium Hikes: A Steep Climb Ahead
A Surge in ACA Premiums for 2026
According to the Kaiser Family Foundation (KFF), ACA insurers have proposed a median 18% increase in marketplace premiums for 2026—more than double last year’s 7% figure . Preliminary filings from 312 insurers across all 50 states and the District of Columbia reveal that most proposed hikes range between 12% and 27%—with some as extreme as 20% or higher . These projections mark the largest ascent in premiums since 2018, when policy instability similarly contributed to major rate increases. Early analyses, limited to 105 insurers in 19 states plus D.C., initially reported a 15% median increase, already flagged as the highest seen in years.
Drivers Behind the Premium Increases
Health insurers attribute these proposed hikes to several converging pressures:
The ongoing rise in healthcare service and drug costs, inflated labor expenses, and boosts in care usage;
The looming expiration of enhanced ACA premium tax credits, initially enacted under the American Rescue Plan and extended via the Inflation Reduction Act, scheduled to lapse at the end of 2025.
Notably, the expiration of these subsidies could lead to an average 75% increase in out-of-pocket premiums, as healthier individuals may exit the market, thereby undermining risk pools and amplifying costs for remaining enrollees.
2. Legislative Shifts: The One Big Beautiful Bill Act
Sunsetting Subsidies, Tighter Rules
On July 4, 2025, President Trump signed the reconciliation legislation popularly known as the One Big Beautiful Bill (OBBBA). The Congressional Budget Office (CBO) projects that the bill, along with the expiry of enhanced ACA subsidies and new marketplace rules, could result in up to 16.9 million Americans losing health coverage by 2034.
This includes:
11.8 million losing coverage through Medicaid or the ACA due to the bill’s provisions;
An additional 5.1 million projected to lose coverage from subsidy expiration and eligibility rule changes.
Another CBO estimate pegs the total impact at 10.9 million Americans losing insurance by 2034.
New Enrollment Hurdles
The legislation introduces stricter eligibility verifications—requiring annual, comprehensive documentation of income, household size, immigration status, and more—ending the era of automatic re-enrollment. Additionally, the ACA’s current open enrollment period will likely be shortened to just six weeks.
Policy Adjustments and Silver Linings
Despite the detriments, there are some framework changes that could benefit certain consumers. Notably, Bronze and Catastrophic plan holders may now be permitted to open Health Savings Accounts (HSAs)—an option that enables relatively healthy individuals to pay for care using tax-advantaged funds.
3. Broader Context: Inflation, Health Costs, and Market Pressures
Cost Drivers Beyond Policy
Premium hikes stem not only from legislative changes but also from deeper cost structures. Nationwide, healthcare expense growth—spanning ER visits, mental health services, GLP‑1 medications, gene therapies, and cancer treatments—is exerting significant upward pressure on premiums.
State-Level Impacts
In Connecticut, insurers are requesting premium increases averaging 17.8% for individual plans and 13.1% for small-group plans—subsidy expiration cited as a central driver.
In Colorado, projections show premiums could spike as high as 28% for some—with subsidy sunset and truncated enrollment window exacerbating the impact.
Employer-Sponsored Coverage
Rising employer-sponsored insurance costs are also shifting toward employees, through higher deductibles, increased drug costs, and additional cost-sharing measures.
4. What Consumers Can Do Now
As these substantial changes take effect, being proactive is critical:
Compare Plans Carefully
Examine the annual notices closely—premium rates, deductibles, out-of-pocket caps, especially if subsidies change.Manage Your Income Strategically
Staying within income thresholds helps retain eligibility for subsidies. Contributors to traditional IRAs or HSAs might better align income for qualification.Take Advantage of HSAs (If Available)
If eligible, HSAs can help offset costs for routine care or medications using pre-tax dollars.Use Prescription Cost Tools
Cancer therapies, GLP‑1s, and other pricey drugs can have serious impact—services like GoodRx or opting for generics may bring relief.Prepare for Complex Enrollment Landscapes
With shorter open enrollment and annual eligibility verification, missing deadlines or documentation can jeopardize coverage—even unintendedly.
5. Summary Table: Key Highlights
AspectWhat to WatchPremium IncreaseMedian jump of 18% across ACA plans for 2026; some insurers request 20%+ hikesSubsidy ChangesEnhanced credits expire end of 2025; could translate to ~75% higher premiumsNew RulesAnnual verification requirements and a shortened enrollment window restrict ease of accessCoverage Loss ProjectionsBetween 10.9 million and 16.9 million Americans may lose coverage by 2034Unexpected PerksBronze and Catastrophic plans may now allow HSA contributions
Bottom Line
In 2026, ACA marketplace participants face a perfect storm—soaring premiums, reduced subsidies, stricter rules, and evolving health cost dynamics. The resulting environment promises hardship for many, particularly those just above subsidy thresholds or facing income instability. Yet, smart planning—monitoring finances, leveraging HSAs if available, and maximizing enrollment opportunities—can provide some necessary buffer in the weeks ahead.