With plenty of policy questions still up in the air, a new report suggests insurers are set to propose steep premium increases for Affordable Care Act (ACA) plans in 2026.
Researchers at KFF examined early filings from 105 insurers in 20 markets, including 19 states and the District of Columbia, and found that the medium premium increase proposed for next year is 15%. The median premium increase for 2025 was 7%, according to the report.
While these filings are preliminary and can change, the analysts said payers are pointing to a complex policy environment that makes reversing course from large increases unlikely.
For instance, the enhanced premium subsidies put in place during the COVID-19 pandemic are set to expire at the end of this year, barring an intervention from Congress that doesn’t seem to be coming. These tax credits drove record-breaking enrollment on the exchanges, and KFF estimates that this alone will increase out-of-pocket premium expenses for members by 75% in 2026.
The end of the tax credits drove a 4% rate increase on average, according to the filings.
In addition, payers expressed concern about tariff policy, as the exact route the Trump administration will take on the issue remains uncertain. Higher tariffs could increase the cost for certain medications, medical devices and supplies, and the report estimates that this threat is behind rate increases that are 3% higher than is normal.
“Each spring and summer, health insurers submit rate filings to state regulators to justify premium changes for the coming calendar year,” the researchers wrote. “Several factors drive premium changes, and usually the cost of medical care… is the primary driver of premiums.”
“However, heading into 2026, there are also policy changes that insurers expect will drive up their costs and, thus, increase premiums beyond what they would otherwise charge,” they said.
Overall, the researchers expect to see premium increases at the highest levels since 2018, when the effort to repeal and replace the ACA similarly established an uncertain policy environment for payers.
Most payers included in the report are proposing increases of between 10% and 20%, with 32 proposing between 10% and 15%, and 24 pitching increases of between 15% and 20%. But 27% listed increases of 20% or more, compared to the 3% that requested similar increases for the 2025 plan year.
None of the insurers included in the analysis requested a rate decrease for 2026, while in recent years some have proposed premium cuts.
Final rate changes will be published by the end of the summer, KFF said.