After several volatile years after the Affordable Care Act was first implemented, individual Marketplace premiums have become more similar to employer-sponsored coverage.
“When insurers entered the ACA Marketplaces in 2014, they were operating with virtually no experience participating in an individual market like this,” according to a Peterson-KFF Health System Tracker report. “Insurers must submit premiums almost a year in advance for review and approval by state regulators, so even 2015 premiums were submitted in early 2014 when the market was first opening, meaning insurers did not have experience in the market on which to base their premium and claim projections.”
Although the ACA included some changes to employer-sponsored health insurance as well, particularly for plans sold to small companies, the changes were more minimal for larger employers, which generally already offered more comprehensive health insurance before the ACA.
In 2019 and beyond, the individual market began to stabilize and premiums began to look much more similar to employer market premiums. By 2022 through 2024, around 85% of individual market premiums were paid out in claims market-wide, illustrating that premiums more closely reflected the health needs of the risk pool.
In 2024, individual market insurance premiums averaged $540 per member per month, slightly below the average $587 premium for fully insured employer coverage. The average amount insurers paid out for health care claims in the individual market was $467 per member per month, which also was slightly below the $512 that fully insured employer plans paid on behalf of their enrollees.
On average in 2025, ACA individual market plans have a $2,789 annual deductible, which is higher than the average deductible for a worker with employer-sponsored coverage ($1,886 across all firm sizes) but closer to the average deductible among small firms ($2,631).
Looking ahead to 2026, private insurance premiums are expected to rise for both employer-sponsored and individual market coverage.
“Insurers in the individual and small-group insurance markets cite similar factors driving up 2026 premiums, such as hospital costs, high utilization of expensive GLP-1 medications and the threat of tariffs,” the repost said.
“However, it is likely premiums will grow faster in the ACA individual market than in the group market. Part of this is due to the expected expiration of the enhanced premium tax credits, which has led insurers to expect an overall sicker population to retain coverage. On average, individual market insurers attributed 4 percentage points of their 2026 premium increase to the expiration of enhanced premium tax credits.”