Starting next year, Americans using the federal health insurance marketplace will face much higher premiums. Insurers have finalized rates that could push costs up by an average of 30 percent for 2026, the biggest jump since the Affordable Care Act (ACA) began in 2014. This change affects about 17 million people who rely on Healthcare.gov for their health coverage.
The Centers for Medicare and Medicaid Services set these new prices amid a federal government shutdown and ongoing political battles over whether to extend the extra financial help added during the pandemic. These additional subsidies, launched under the American Rescue Plan and extended by the Inflation Reduction Act, are set to expire at the end of this year unless Congress steps in. Democrats argue these supports are needed to offset rising costs caused by inflation. On the other hand, Republicans say they were always meant to be temporary. If the subsidies end, many households could see their premiums double or even triple.
The federal marketplace will open for early rate shopping next week, giving consumers a preview of what to expect before open enrollment starts on November 1.
The rising premiums come at a tricky time for insurers. After a few years of steady or declining benchmark premiums from 2018 through 2022, enrollment has surged to 24 million people this year—more than double since 2020. But growing medical expenses, including drug prices and hospital bills, combined with the threat of losing subsidy support, put insurers under pressure. Without continued aid, healthier people might drop their coverage, which could drive up costs for everyone.
Some states are already showing early signs of these changes. Idaho, which started its enrollment early, reported a 10 percent rise in gross premiums, but a much sharper 75 percent increase in what consumers pay after tax credits. About 13,000 Idaho residents earning above 400 percent of the federal poverty level could lose access to premium tax credits if Congress doesn’t act, possibly getting reenrolled automatically without understanding how much more they will owe.
The impact of subsidy loss won’t be the same everywhere. States that expanded Medicaid, such as California and North Carolina, may see less disruption. Meanwhile, states that didn’t expand Medicaid—like Mississippi, Tennessee, and South Carolina—could face bigger spikes in uninsured rates. Some congressional districts in states including Wyoming, West Virginia, Connecticut, and Illinois might experience premium increases ranging from 535 to 700 percent, according to data from health policy organizations.
Insurance carriers are also considering other ways to cope. Some states are bringing back high-risk pools, which have historically helped lower premiums by about 20 percent in certain areas.
In Idaho, many shoppers rely heavily on licensed brokers, so officials are encouraging people to seek help early. “We’re ready to do whatever it takes to make sure people get the savings they qualify for,” said Pat Kelly, head of Your Health Idaho.
This year could be a turning point for the ACA marketplace. Whether it keeps growing or faces more instability will depend a lot on upcoming political decisions and how well insurers can adjust to these challenges.
For some perspective, here’s a quick look at enrollment numbers from 2025: Florida leads with 3.5 million marketplace enrollees, followed by Texas with 2.3 million, California with 1.8 million, and several other states ranging from half a million to just over a million enrollees. Overall, about 24 million Americans are covered through the federal marketplace.
With open enrollment approaching, many will be watching closely to see how these premium hikes impact coverage choices and affordability in the year ahead.