People who buy health insurance through the Affordable Care Act (ACA) could see a major spike in their premiums next year, at the same time enhanced subsidies that most people rely on are set to expire.

According to an analysis of preliminary filings by KFF released Friday, insurers are planning an average premium increase of 15 percent in 2026, the largest hike since 2018. The analysis is based on filings from more than 100 insurers in 19 states and Washington, D.C.

That’s a sharp rise from recent years. For the 2025 plan year, for example, KFF found that the median proposed increase was 7 percent.

Most ACA insurers are proposing premium increases of 10 percent to 20 percent for 2026. But more than a quarter are proposing premium increases of 20 percent or more, KFF found.

No insurers have requested rate decreases for 2026, whereas in recent years at least some insurers did decrease premiums.

Insurers said they wanted higher premiums to cover rising health care costs, like hospitalizations and physician care, as well as prescription drug costs.

But they are also adding in higher increases due to changes being made by the Trump administration and Republicans in Congress. For instance, KFF found many insurers cited the likely expiration of enhanced premium tax credits as a reason for increased premiums.

Those subsidies, put in place during the COVID-19 pandemic, are set to expire at the end of the year, and there are few signs that Republicans are interested in tackling the issue at all.

If Congress takes no action, premiums for subsidized enrollees are projected to increase by over 75 percent starting in January 2026, according to KFF.

Companies said they will raise premiums by an additional 4 percent more than they would have if the enhanced tax credits were renewed.

More than 24 million Americans are enrolled in the insurance marketplace this year, and about 90 percent — more than 22 million people — are receiving enhanced subsidies. According to the Congressional Budget Office, 4.2 million people are projected to lose insurance by 2034 if the subsidies aren’t renewed.

According to federal data, the average monthly premium was $113 last year due to the subsidies, compared with $162 in 2020.

When premiums become less affordable, the first people to drop out of the market are those that are healthier. With fewer people enrolled, experts have said insurers would have to spread the costs among a smaller group of sicker people, meaning premiums will be higher.

Finalized 2026 rate changes are expected to be published later this summer.

Ahead of the upcoming Affordable Care Act (ACA) enrollment period in November, the nation’s health care marketplace insurers are seeking the largest premium increases in more than five years, according to a new analysis by the Peterson Center on Healthcare and health policy nonprofit KFF.

The report, released July 18, highlights several factors driving up insurance rates for 2026, as major health insurers submit rate filings to state regulators to justify premium changes for the upcoming calendar year.

“As in most years , rising healthcare costs—both the price of care and increased use—are a significant driver for increasing rates going into plan year 2026. The costs of healthcare services like hospitalizations and physician care, as well as prescription drug costs, tend to go up every year, and insurers often raise premiums to cover their increased costs,” the report states.

The KFF analysis examines insurers in the District of Columbia and 19 states: Connecticut, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon, Rhode Island, Texas, Vermont, and Washington.

Finalized 2026 rate changes are expected to be published in late summer, and individuals will be able to see how their plans’ premiums are changing just before open enrollment begins in November.

The report states that heading into 2026, there are also policy changes that insurers expect will drive up their costs, increasing premiums beyond what they would otherwise charge. Among them are enhanced Affordable Care Act (ACA) premium tax credits, which make coverage more affordable and will expire at the end of 2025, resulting in an average increase of more than 75 percent in out-of-pocket premium payments. The impact will vary depending on income and family composition.

“This is expected to cause healthier enrollees to drop their coverage and create a sicker risk pool,” the report states.

An earlier Peterson–KFF Health System Tracker analysis found that the expiration of enhanced premium tax credits increased proposed rates by an average of 4 percent. The earlier Peterson-KFF report also stated that there would be gross premium increases, as healthier people are expected to drop their coverage in larger numbers due to increases in their net premium payments.

The Congressional Budget Office (CBO) projects that, on average, gross benchmark silver premiums will ultimately be 7.9 percent higher than they would otherwise be as the risk pool becomes sicker, on average, and that many enrollees will become uninsured.

“Unless the premium tax credits are extended, consumers can expect increases in both the net premium payments and gross premiums,” the June 3 report states.

Tariffs could also drive up the cost of certain drugs, medical equipment, and supplies, the July 18 report stated. It further notes that some insurers report that tariffs—and the uncertainty surrounding them—are causing rate increases.

A June 18 Peterson-KFF report stated that Optimum Choice of Maryland, Independent Health Benefits Corporation of New York, and UnitedHealthcare of New York are increasing premiums by 2.4 percent, 2.9 percent, and 3.6 percent, respectively, due to the impact of tariffs on pharmaceuticals.

Many insurers submitted proposed rates before Congress passed the budget reconciliation legislation and the Centers for Medicare and Medicaid Services (CMS) finalized the Marketplace Integrity and Affordability rule. The legislation and new Medicaid rules, which explain how the ACA marketplace operates and how individuals enroll, were only finalized recently, and it is still unclear how insurers might respond, the report states.

“Early indications are that individual market insurers will be increasing premiums in 2026 by more than they have since 2018, the last time policy uncertainty contributed to sharp premium increases,” the new Peterson-KFF report stated, noting that across 105 ACA Marketplace insurers in 20 markets, premiums are increasing by a median of 15 percent.

Another factor creating uncertainty in the rate filing process is the implementation of the Trump administration’s ACA integrity rule. Based on what insurers have filed so far, this does not generally appear to be driving rate changes in either direction, the report states.

“Insurers and state regulators are still finalizing rates for the upcoming plan year, so these filed premium increases may change,” the report stated.

People who get health insurance through the Affordable Care Act could soon see their monthly premiums sharply increase as subsidies expire and insurers propose a major premium hike for 2026.

Insurers that offer plans through the ACA are planning an average premium increase of 15% for 2026 — the largest increase in seven years, according to an analysis published Friday from KFF, a health policy research group. The analysis is based on filings from more than 100 insurers in 19 states and Washington, D.C.

The increase will likely come on top of the loss of enhanced subsidies that helped people pay for ACA health plans by capping the costs at a certain proportion of their income.

The finalized plans — including how much more people will be expected to pay each month — are usually published around August.

​​The enhanced subsidies came out of the 2021 American Rescue Plan and broadened the number of people eligible, including many in the middle class. The Inflation Reduction Act, passed in 2022, extended the subsidies through 2025.

The domestic policy bill that President Donald Trump signed into law earlier this month, however, did not extend them further. (Subsidies for people with very low incomes that were put in place when the ACA was enacted will still be available.) The bill also added more hurdles for people who get their health insurance through the ACA, such as adding new paperwork requirements to renew coverage each year.

Nearly 4 million people were projected to lose their coverage next year if the subsidies weren’t extended, according to a 2024 analysis from the Congressional Budget Office, a nonpartisan agency that provides budget and economic information to Congress.

A loss of coverage would also have implications for the cost of insurance.

With fewer people enrolled, insurers would have to spread the costs among a smaller group of people, pushing premiums higher, said Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy.

An earlier analysis from KFF, published this month, found that more than 22 million people could see a sharp premium increase starting Jan. 1.

“This is not a repeal [of the ACA], but it’s certainly an attempt to move in that direction,” Park said. “It’ll be much more costly, so that means it’ll be less affordable for you to purchase a plan or renew your coverage.”

Chris Meekins, a health policy research analyst at the investment firm Raymond James who served in the first Trump administration, said the chances that Congress will extend the subsidies in time for next year are slim, as Trump and other Republicans have signaled that they don’t support them.

Higher out-of-pocket costs

ACA enrollment reached a record high last year, totaling more than 24 million people, according to the Centers for Medicare & Medicaid Services. Much of that growth was from the extended subsidies, the agency said. The average monthly premium was $113, compared with $162 in 2020.

According to KFF’s latest analysis, most ACA insurers are proposing premium increases of 10% to 20% for 2026. More than a quarter, the group said, are proposing premium increases of 20% or more.

What people actually end up paying out of pocket for their monthly premiums could increase, on average, by more than 75%, Larry Levitt, the executive vice president for health policy at KFF, said on a call with reporters last week.

A family of three earning $110,000 a year and enrolled in a silver ACA plan — which usually comes with moderate monthly premiums — could see their monthly cost jump from $779 this year to $1,446 in 2026 when the enhanced subsidies expire, according to KFF. If insurers raise premiums by 15%, the monthly bill could climb even higher, to $1,662.

Some people may be able to keep their coverage by paying more in premiums each month or dropping down to so-called high-deductible plans, which have lower monthly premiums but require people to pay more out of pocket before coverage kicks in, Cynthia Cox, director of the program on the ACA, said on the same call.

Along with the other changes in the domestic policy bill, “it amounts to what is effectively a partial repeal of the ACA, erasing a lot of its gain in health coverage,” Levitt said.

The subsidies on track to expire, however, aren’t the only factor insurers are taking into account in their premium proposals, KFF’s analysis found.

They’re also concerned about the potential impact of tariffs on some drugs, medical equipment and supplies.

Earlier this month, Trump threatened to impose up to 200% tariffs “very soon” on pharmaceuticals imported into the U.S. The majority of prescription drugs that people take in the U.S. are manufactured overseas.

Insurers also cited the anticipated growth in the cost of health care services, according to KFF. They also mentioned the cost of GLP-1 drugs, a class of medications that include the blockbuster drugs Ozempic and Wegovy. The drugs can cost more than $1,000 for a monthly supply.

On Thursday, a group of Democratic attorneys general filed a lawsuit to block a separate rule by the Trump administration that also makes changes to the ACA.

Maine Attorney General Aaron Frey joins a multistate suit to block a federal rule expected to limit ACA access and increase insurance costs.

AUGUSTA, Maine — Maine Attorney General Aaron Frey has joined a coalition of 20 attorneys general and Pennsylvania Gov. Josh Shapiro in a lawsuit challenging a Trump administration rule that could sharply reduce enrollment under the Affordable Care Act, or “Obamacare,” as it’s also known.

The final rule, issued by the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services, is set to take effect Aug. 25. It shortens the ACA open enrollment window, imposes new verification requirements, allows insurers to deny coverage to people with unpaid premiums, and eliminates automatic re-enrollment for some zero-premium plans. It will also bar about 100,000 people who were brought illegally into the country as children from enrollment. Those are grouped under the Obama-era Deferred Action for Childhood Arrivals (DACA) plan.

The rule also excludes gender-affirming care from essential benefits coverage under the ACA’s federal marketplace plans. States would be responsible for covering the cost of that care if mandated locally.

The administration estimates up to 1.8 million people, or about 10%, could lose coverage under the changes, while others may face higher out-of-pocket costs. The lawsuit argues that the rule violates the Administrative Procedure Act and requests that the court block its implementation.

Frey said the rule would create “unnecessary barriers” for the nearly 65,000 Mainers who use Maine’s state-based exchange, CoverME.gov.

“Not only is the rule not about efficiency or reducing waste, but it is intentionally designed to create more red tape and make enrollment harder,” Frey said in a statement. “We know that when people do not have health insurance, they wait until their health issues become worse, more expensive, and less treatable. Once again, this is a cruel attack on the structures that keep citizens well.”

States joining the legal challenge include California, Massachusetts, New Jersey, Arizona, Colorado, Connecticut, Delaware, Illinois, Maryland, Michigan, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington, Wisconsin, and Maine.

The lawsuit follows a separate challenge filed by Democratic mayors in Baltimore, Chicago, and Columbus, Ohio, as well as advocacy groups Doctors for America and Main Street Alliance. That case argues the rule will increase the number of uninsured Americans and strain city resources.

Supporters of the new rule, including HHS spokesperson Andrew Nixon, say it will reduce fraud and ensure subsidies go only to eligible enrollees.

More stories from NEWS CENTER Maine

Highlights

Double premium hit coming : 15 percent average rate increases plus loss of enhanced federal subsidies currently saving most Louisiana enrollees over $600 monthly

: 15 percent average rate increases plus loss of enhanced federal subsidies currently saving most Louisiana enrollees over $600 monthly Enhanced subsidies expire December 31, 2025 : Without Congressional action, out-of-pocket premiums could rise by more than 75 percent

: Without Congressional action, out-of-pocket premiums could rise by more than 75 percent Record enrollment amplifies impact : Louisiana’s 234 percent marketplace growth since 2020 means hundreds of thousands more residents are affected

: Louisiana’s 234 percent marketplace growth since 2020 means hundreds of thousands more residents are affected Perfect storm of cost drivers : Medical inflation, subsidy cliff, and tariffs on medical supplies converging simultaneously

: Medical inflation, subsidy cliff, and tariffs on medical supplies converging simultaneously Shocking increase from current rates: Average Louisiana enrollees pay only $107 monthly after subsidies, making the 2026 changes devastating

Louisiana Families Face Massive Health Insurance Premium Increases in 2026

Louisiana families who depend on ACA marketplace health insurance are about to get blindsided by the largest premium increases in more than five years.

LAFAYETTE, La. (KPEL News) — Enhanced federal subsidies that have kept coverage affordable will disappear while insurers impose the largest premium increases in more than five years.

New analysis from the Peterson-KFF Health System Tracker shows health insurers nationwide are requesting premium increases averaging 15% for 2026 — the largest since 2018. Louisiana residents will also lose enhanced federal subsidies that expire on December 31, 2025.

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Right now, 96% of Louisiana’s marketplace enrollees get federal subsidies averaging $666 per month. This cuts their actual premium payments to about $107 monthly. KFF analysis shows that without Congressional extension, out-of-pocket premiums would jump more than 75%.

More Louisiana Residents Will Feel the Impact

Louisiana’s marketplace enrollment has grown 234% since 2020, making it one of the fastest-growing ACA marketplace states. This means far more Louisiana families will face premium increases than in previous years.

Enhanced subsidies have made coverage affordable for most Louisiana residents. Four out of five people enrolling through HealthCare.gov find plans for $10 or less per month after federal assistance.

A family of four earning $85,000 annually will pay an extra $313 monthly just from losing enhanced subsidies. Add the 15% premium increases insurers want, and costs climb even higher. A 45-year-old earning $25,000 will see monthly payments jump from $160 to $1,077.

What’s Driving Premium Increases Higher

Several factors are pushing Louisiana’s health insurance costs up:

1. Medical Costs Keep Rising

Healthcare costs rise about 8% annually. Hospital and physician services cost more. Expensive medications like GLP-1 diabetes drugs add to expenses. Healthcare worker shortages drive up wages, which affects provider contracts.

2. Enhanced Subsidies Disappearing

Enhanced premium tax credits expire at year’s end, recreating the “subsidy cliff” that existed before 2021. Early rate filings show insurers expect this alone to drive premiums up another 4% as healthier people drop coverage.

3. Tariffs on Medical Supplies

Some insurers are building tariff costs into 2026 rates. KFF analysis shows companies are adding about 3% to premiums for expected increases in drug and medical device costs.

Louisiana’s Health Insurance Options

Louisiana residents buy marketplace plans through five companies on HealthCare.gov: Blue Cross Blue Shield of Louisiana, CHRISTUS Health Plan, Louisiana Healthcare Connections (Ambetter), UnitedHealthcare, and HMO Louisiana. Recent analysis shows Ambetter offers the cheapest Silver-tier plans at $391-458 monthly before subsidies.

READ MORE: How Much of Your Louisiana Income Does Health Insurance Take?

Most Louisiana enrollees pay about $107 monthly after federal assistance.

Policy Background

Enhanced premium tax credits started with the American Rescue Plan Act in 2021. The Inflation Reduction Act extended them through 2025. These subsidies increased federal assistance and let families earning above 400% of the federal poverty level qualify for help.

Recent budget legislation did not extend enhanced premium tax credits. The Congressional Budget Office projects 4.2 million Americans will lose insurance over the next decade if enhanced subsidies end.

Enhanced subsidies matter more in Louisiana because the state didn’t expand Medicaid under the ACA. This created a coverage gap that marketplace subsidies help fill for working families who earn too much for traditional Medicaid.

Who Gets Hit Hardest

Premium changes will affect different Louisiana residents differently:

1. Lower-income families getting the largest subsidies will see the biggest premium jumps. Some will drop coverage or switch to high-deductible plans with lower monthly costs but higher out-of-pocket expenses.

2. Self-employed workers and small business owners buying individual coverage must weigh keeping current benefits against higher costs.

3. Middle-income families who qualified for subsidies under the enhanced system may lose help entirely.

Getting Ready for 2026

Louisiana residents with ACA marketplace plans should prepare for open enrollment starting November 1, 2025. State insurance regulators will publish final premium rates in late summer 2025.

Original federal subsidies from the Affordable Care Act will continue for qualifying households, though at lower levels than the enhanced version ending in 2025.

Congress could extend enhanced subsidies before they expire. Court challenges to other marketplace rule changes are pending.

Louisiana residents can work with licensed insurance agents or certified application counselors to understand options and plan for changes during the upcoming enrollment period.

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Enhanced subsidies have made comprehensive health coverage affordable for hundreds of thousands of Louisiana residents since 2021. Losing them will change healthcare affordability across the state.

For families counting on current premium levels, the 2026 changes will require careful budgeting and planning. The combination of higher baseline premiums and reduced federal help will test many Louisiana households’ ability to maintain comprehensive health coverage.

Premium rate increases described here are preliminary filings from insurance companies. Louisiana insurance regulators may modify them throughout 2025.