Affordable Care Act Marketplace Premiums Expected to Skyrocket

Insurers with Affordable Care Act (ACA) Marketplace plans have submitted their rates for 2026 and they show a massive spike in premiums. A new KFF analysis shows that ACA insurers are hiking premiums by a median rate of about 18%, the largest increase since 2018. These numbers reflect a great deal of uncertainty, inflation, and economic instability affecting the health care market.

Most of these factors are out of congressional control. One aspect, however, could still be changed. KFF estimates that a set of tax credits that are set to expire at the end of 2025 are driving around 4% of the premium spike.

Enhanced Premium Tax Credits

Premium Tax Credits (PTC) help people with low or middle incomes pay their Marketplace premiums. Congress enhanced the PTCs in 2021 and these “enhanced” PTCs have made huge gains in reducing the number of uninsured people.

In 2024, nearly five million people aged 50–64 got premium tax credits.

Enhanced PTCs are especially valuable for people aged 50–64 who are not yet eligible for Medicare. In 2024, nearly five million people in this category got PTCs, and one analysis by Avalere estimated that the current PTCs save the 50+ ACA population a minimum of $599 per year, reaching $4,574 for some enrollees.

A portion of these credits, enhanced PTCs, are set to expire and analysts agree that rising costs will push many people out of their health insurance coverage. KFF projects the new premiums will increase by over 75% on average with premiums at least doubling in 12 states.

Millions Will Lose Coverage

The Congressional Budget Office estimated that loss of the enhanced PTCs would increase the number of uninsured people by millions: “the number of uninsured people will rise by 2.2 million in 2026, by 3.7 million in 2027, and by 3.8 million, on average, in each year over the 2026–2034 period.”

These losses come on top of other actions by Congress and the Trump administration like cuts and new administrative burdens that will terminate coverage for additional millions of people with ACA plans, Medicaid, and Medicare.

Cuts and coverage losses will drive up costs for the Medicare program by increasing the uninsured rate for those nearing eligibility.

All of these cuts and coverage losses will also drive up costs for the Medicare program by increasing the uninsured rate for those nearing eligibility, which in turn worsens health and delays access to care.

It’s Not Too Late to Extend the Expiring Enhanced PTCs

While Congress has so far passed up the opportunity to extend these PTCs, it’s not too late. Members could still choose to extend them and preserve a portion of the ACA’s major reduction in the uninsured rate.

Medicare Rights will continue to advocate for an extension of the PTCs and other congressional actions that can reverse or mitigate the expected coverage losses. This includes pushing for a complete rejection of the reconciliation bill’s devastating health care cuts. We urge all policymakers to prioritize reducing the uninsured rate and helping people gain access to affordable, high-quality care.