ACA Premiums Jumped 26% but Enrollee Payments Rose Even Faster

The ACA warning has come true

In late October 2025, KFF warned that the gap between what Affordable Care Act insurers charge and what enrollees actually pay was about to become very costly. Its analysis found that insurers on the ACA Marketplaces were raising premiums by about 26% on average for 2026. Benchmark silver premiums were set to rise 30% in states using HealthCare.gov and 17% in states that run their own exchanges.21 The bigger point was in the second half of the analysis. For the roughly 22 million of 24 million enrollees who received a tax credit, the insurer's price was not the number that mattered. What mattered was whether Congress would extend the enhanced premium tax credits. If it didn't, KFF estimated that subsidized enrollees' monthly payments would rise about 114% on average.21

Congress did not extend them. A year later, there is enough data to say what happened. Enrollees did take a large hit. But the hit showed up in more than one place: people bought cheaper plans with higher deductibles, and many left the market entirely. And the shock is now feeding into 2027 rates. The ACA story also stands apart from the wider rise in insurance costs. Auto and home insurers have raised prices too, but at a much slower pace.

What happened to ACA enrollees

KFF's mid-2026 review found that the average monthly premium payment, after tax credits, rose 58%, from $113 to $178.22 That is well below the 114% forecast. The forecast was not wrong, though. It assumed people would keep the same plan, and many did not.22 Large numbers of enrollees switched to bronze plans, which have lower premiums but much higher deductibles. The people facing the steepest increases, those who lost tax credit eligibility altogether, appear to have dropped coverage at unusually high rates.22

The 58% figure therefore understates the damage. Lower monthly payments came with much larger exposure to medical bills. Average Marketplace deductibles rose 37%, or $1,027 per person, to a record $3,786 in 2026.28 KFF had warned of exactly this trade-off. Lower-income enrollees could still find bronze plans with little or no premium, but switching from a cost-sharing silver plan could mean going from a deductible under $100 to one above $7,000.21

The people who left show the same pattern. People with incomes just above the subsidy cliff, between 400% and 500% of the federal poverty level, made up about 3% of 2025 plan selections. They account for 27% of the drop in sign-ups.22 By February, ACA enrollment was down about 3 million from a year earlier.27 KFF's Cynthia Cox argues that the people who left were mostly the healthier ones, since sicker enrollees had more reason to find a way to keep paying.27 The Trump administration disputes that reading and says much of the enrollment growth under Biden was fraudulent.27

Enrollees feel the strain. In a KFF follow-up survey, 51% of people who re-enrolled said their costs were "a lot higher," and 80% said their premiums, deductibles or copays had gone up.29 Seventeen percent were not sure they could keep paying premiums for the rest of the year.29 Asked who was to blame, 70% pointed strongly at insurers, 54% at congressional Republicans and 53% at President Trump.29 Nearly half said health costs would have a major effect on how they vote in the midterms.29

How big was the increase in what insurers charged?

The 26% figure is the most widely cited, but estimates differ on how large the 2026 increase really was. An Urban Institute analysis put the national average benchmark increase at 21.7%. It attributes the gap mainly to how premiums are weighted across rating regions and states.25 The Peterson-KFF Health System Tracker described insurers as raising premiums by about 20%, with a median proposed increase of 18% across 312 insurers.24 Later reporting put the median finalized increase at 20%.28

These numbers measure different things: average benchmark premiums, median insurer filings and population-weighted figures. They do not contradict each other. The important point is that every estimate shows a break from the recent past. Urban notes that the 2026 increase followed five years in which benchmark premiums rose only about 2% a year. Employer plans, by comparison, were expected to rise around 6% to 7%.25

All the analyses also agree on the main causes. Hospital and other medical prices are rising, labor costs are climbing, and spending on expensive GLP-1 drugs is growing. Insurers also cited the risk of tariffs.2124 One factor applies only to the Marketplaces: insurers expected the subsidy expiration to drive out healthier customers. They built in about 4 extra percentage points for that reason.2124 So the end of the credits did more than raise enrollees' net costs. It also helped push up the full price that insurers charge.

This has a cost for taxpayers too. Tax credits are pegged to the benchmark silver plan, so higher benchmark premiums automatically increase federal subsidy spending for the people who remain.21 Letting the enhanced credits expire saved money on one side of the budget and added costs on the other.

2027: another round

The expected outflow of healthier enrollees appears to be happening, and it is now showing up in prices. In 2027 filings, ACA insurers proposed a median increase of about 15% across 276 carriers. Most requests fell between 10% and 25%, and 51 insurers asked for more than 25%.26 Insurers again pointed to the end of the enhanced credits and a sicker risk pool, saying healthier people were more likely to have dropped coverage in 2026.26 Peterson-KFF again put the effect of the subsidy expiration at about 4 percentage points.27 Some insurers also cited Trump administration policy changes that are expected to make enrolling harder.27

Cox calls it a "triple whammy" for consumers: higher premiums in 2026, the loss of the enhanced credits, and now another round of double-digit requests.27 People just above four times the poverty line, who no longer get any subsidy, are hit hardest over the two years combined.26

This is the most important takeaway from the past year. The insurance industry has long warned about a "death spiral," in which healthy people leave, prices rise and more people leave.23 The 2026–2027 data do not show a collapse. They do show the early stages of that cycle, with insurers openly pricing it in.

Auto insurance: back to modest increases

Outside health care, insurance prices are rising too, but the pattern is very different. Car insurance went through its own spike after the pandemic, with rate increases of 11.57% in 2023 and 17.13% in 2024, according to ValuePenguin. It projects an increase of only 0.67% for 2026.1120 Insurify data show full-coverage premiums fell 6% in 2025 and then rose 1% in the first half of 2026, to $2,237 a year. Rates have gone up in 27 states so far, and Insurify expects increases in 32 states by year-end.12

The national figures hide big differences between states. Insurify projects Connecticut up 15%, with Kentucky and West Virginia up 8% each.1218 ValuePenguin and The Zebra both rank New Jersey among the steepest increases at roughly 10%.1320 Insurify, however, shows New Jersey premiums falling 5% in the first half of the year.12 Because each firm uses different methods and time periods, state rankings should be treated as rough. Overall, auto insurance looks like it is returning to normal: increases are small, and insurers are partly shifting prices from expensive states to cheaper ones.12

Home insurance: still rising, but more slowly

Home insurance sits between the two. Insurify projects a 4% increase in 2026, to about $3,057 a year. That follows a 12% jump in 2025 and would make it the fifth straight year of increases. Premiums are up 46% since 2021.1 Cotality expects a larger 8% increase in both 2026 and 2027.7 NerdWallet's analysis of rate data found prices up 24% over three years but only 4.6% over the most recent year. The median rate change insurers requested for 2026 is just 1%.4 Weather is the main driver. Severe storms are pushing up costs in the Midwest and Plains, while California faces a projected 16% increase after the Los Angeles wildfires.249

Assessment

For auto and home insurance, the main causes are physical: repair costs, rebuilding costs and storms. Those pressures appear to be easing, at least for now. ACA coverage is different, because the biggest shock came from a policy decision. The final question in KFF's 2025 analysis was whether Congress would extend the enhanced credits. It didn't, and the data since then show the result: higher monthly payments, deductibles about $1,000 higher, roughly 3 million fewer enrollees, and a second year of double-digit rate requests. The 26% headline figure understated how much the change would cost enrollees.