Introduction — what’s happening and why you should care.
You’ve probably seen the headlines: discussions about health insurance premium increases 2025 and scary numbers for 2026. For many people, the worry isn’t an abstract statistic — it’s the real risk that your monthly premium, deductible, or out-of-pocket exposure could spike next year. Insurers are citing rising medical costs, expensive new drugs and therapies, lingering mortality trends, and changes to federal subsidies as reasons for the proposed rate increases. Some exchanges are projecting average marketplace increases around 18–20% for 2026, while in worst-case subsidy rollbacks scenarios certain enrollees could face steep net increases — in some pockets figures as high as ~66% have been cited.
Why rates are rising: the short list (and what it means for you)
1) Medical cost trends are unusually high.
Health plan actuaries and industry analysts expect medical cost trends to remain elevated — PwC projects about 8.5% medical cost growth for the group (employer) market in 2026, with individual market trends also high. That directly pushes insurers to seek higher premiums.
2) Marketplace (ACA) rate requests are higher than usual.
Analyses of insurers’ initial 2026 filings show median proposed premium increases in the high teens, translating to roughly ~20% on average for many ACA marketplace plans before any subsidy changes are considered. These are preliminary requests but they show a material jump vs. last year.
3) Federal subsidy uncertainty can make things worse.
Some states highlight a worst-case: if enhanced premium tax credits expire or are cut, many marketplace enrollees would lose subsidy protections — and net premiums for those households could spike dramatically (some state estimates show average net increases of as much as ~66% for affected enrollees if credits aren’t extended). That’s not everyone, but if your subsidy eligibility changes, your cost could change a lot.
4) Employer plans are feeling pressure too.
Employers and plan sponsors are forecasting higher costs, too — surveys and plan announcements point to 8% or more increases in sponsor health spending and some employer rate tables show mid-to-high single-digit premium upticks for 2026. That can mean higher employee contributions or plan design shifts.
5) Other factors: new expensive treatments, excess mortality, and provider costs.
Advances in gene therapies and high-priced specialty drugs, ongoing post-COVID health impacts (so-called excess mortality or higher claims in certain cohorts), rising labor costs at hospitals and ambulatory centers, and general inflation in health services all add pressure. Insurers point to these operational drivers in filings.
What this means for different people — quick scenarios you may face
If you buy on the ACA Marketplace
You may see an insurer-requested median increase around 18% and averages around 20% in many regions before subsidies. If your eligibility for enhanced credits is reduced, your net premium could jump far more (state estimates show extreme cases up to ~66% for some households). Start by checking your subsidy eligibility and modeling your 2026 net premium now.
If you get employer-sponsored coverage
Employers are likely to pass through part of the increased costs via higher employee contributions or changes to plan design — think higher deductibles, higher co-insurance, or narrower networks. Expect employer plan cost pressure in the 8% range in many cases.
If you’re on Medicare or retiree plans
Medicare Part B and Part D premiums are being projected to rise, and if your retiree plan ties to commercial market pricing you may see knock-on effects. (Check the latest CMS and plan notices for finalized numbers.)
The politics and the public reaction — why this is trending
People are angry — and with good reason. The public conversation often ties rising premiums to the fact that large insurers and health-care companies returned large sums to shareholders (dividends, buybacks) while asking regulators for higher premiums. That contrast — shareholders getting returns while consumers face affordability crises — is fueling social media and policymaker attention. For background on buybacks and corporate returns, see mainstream reporting and analysis on stock buybacks growth and specific insurer results.
How to fight back — practical steps you can take right now (your action plan)
Below are concrete moves you can start today. Don’t wait for final notices — many of these take time to set up and can reduce your net 2026 exposure.
1) Model your 2026 costs now (two simple numbers).
Take your current premium and your current subsidy (if any).
Model two scenarios: (A) insurer-requested rate increases only; (B) rate increases + loss of enhanced subsidies. Use the Marketplace estimator tools or a spreadsheet. Doing this gives you an early warning and a concrete dollar target to hit with savings or plan changes.
2) Shop every open enrollment — don’t assume your current plan is best.
If marketplace premiums rise, a different metal tier or a different insurer’s network might become cheaper after you include expected care needs and cost-sharing. Compare total yearly cost: premiums + expected out-of-pocket. (Internal link: compare health insurance options on our site.)
3) Use HSAs aggressively (if you’re eligible).
Max out Health Savings Account (HSA) contributions if you have an HSA-eligible plan — this lowers taxable income and builds a tax-free cushion for medical costs. See our complete HSA guide for contribution limits, tax advantages, and withdrawal rules.
4) Reconsider plan tiering: premium vs. risk.
If you’re healthy and don’t use many services, a high-deductible plan + HSA may still be best. If you expect major care next year, a higher-premium lower-cost-sharing plan could be cheaper in the long run.
(Internal link: complete HSA guide.)
5) Check special enrollment eligibility and short-term or transitional options.
If you lose a subsidy or your employer drops coverage, special enrollment rules sometimes apply. Also review state-sponsored programs or stabilizing funds (some states are offering support if subsidies lapse).
6) Ask your employer about benefit design changes and contribution strategy.
Employers can negotiate and redesign plans. Join benefits meetings, ask HR for total cost projections, and present alternative options (e.g., employer HSA contributions, flexible spending accounts).
7) Price transparency and provider shopping for elective procedures.
For planned care, ask providers for bundled pricing or use cost-estimator tools. When possible, shop for lower-cost in-network providers or ambulatory surgical centers.
8) Consider supplemental coverage and risk-reduction steps.
Short-term supplemental policies, telehealth memberships, and clinic subscription programs won’t replace comprehensive insurance, but they can reduce out-of-pocket spending for specific needs.
How to prioritize — a three-week checklist you can follow before open enrollment
Week 1 — Get the numbers
Download last year’s Explanation of Benefits and your current bill.
Estimate your 2026 premium under two scenarios.
Week 2 — Shop plans and vendors
Use at least two comparison tools and check network differences, drug formularies, and prior-authorization rules.
Week 3 — Optimize taxes and accounts
Maximize HSA contributions (if eligible), finish dependent care FSA elections if helpful, and set aside a buffer in your emergency fund.
Real examples (short case studies) — how families might be affected
Family A — Marketplace with subsidies
Family A currently receives a sizable premium tax credit. If federal enhanced subsidies lapse, their net monthly premium could jump substantially. By adjusting income, they may retain partial help or shift to a different plan tier that reduces total household yearly spend.
Family B — Employer plan
Family B sees a 9% employer plan cost bump. Employer passes 4% to employees and shifts to a slightly higher deductible. Family B offsets some of that via increased HSA contributions and by moving routine care to lower-cost clinics.
What regulators and lawmakers are doing (and what to
Watch for:
Congressional action on premium tax credits (extensions, partial extensions, or new rules). If subsidies are extended, projected worst-case spikes may be mitigated.
State actions: some states are budgeting to cushion exchange enrollees or negotiate rates.
Final rate approvals: insurers’ initial filings are often adjusted by state regulators before the January effective date.
Two external links
KFF / Health System Tracker analysis of 2026 ACA rate filings.
PwC medical cost trend report projecting Group market 8.5% for 2026.
Final Thoughts — Protecting Your Wallet From Rising Premiums
The reality is clear: health insurance premium increases 2025 are setting the stage for even steeper hikes in 2026. You could be facing an average 20% jump on ACA marketplace plans, or 8–9% on employer coverage, with some households staring down worst-case hikes of up to 66% if subsidies lapse.
But here’s the good news: you’re not powerless. By modeling your 2026 costs early, shopping actively during open enrollment, and leveraging tools like HSAs, FSAs, and tax credits, you can soften the blow. Staying engaged with policy developments — especially around subsidy extensions — could also make a meaningful difference to your bottom line.
At the end of the day, the best move is to stay informed, compare your options, and use every financial tool at your disposal. By doing this, you give yourself and your family the best chance to fight back against rising healthcare costs without sacrificing the coverage you need.