Open Enrollment for Affordable Care Act (ACA) marketplace plans begins November 1, and early federal data show that consumers are in for a shock: premiums are set to rise by an average of 30% for 2026, according to filings reviewed by The Washington Post and the Centers for Medicare & Medicaid Services (CMS).
This represents the steepest increase since the exchanges were launched over a decade ago.
Why Are Premiums Rising So Sharply?
Several factors are converging at once:
Expiring Federal Subsidies: Enhanced premium tax credits, first introduced during the COVID-19 pandemic, are scheduled to expire without congressional action. These subsidies have kept coverage affordable and enrollment at record highs.
Higher Utilization & Medical Inflation: Rising demand for care, specialty drugs, and hospital services is driving insurers’ medical costs upward.
Policy Uncertainty: With the government shutdown looming, political divisions have made it unclear whether subsidies will be extended, leaving insurers to price conservatively for 2026.
Analysts at KFF found that insurers’ median premium requests jumped 18%, far above the 7% average increases seen in recent years. CMS has now confirmed final approvals reflecting even steeper hikes in certain markets.
Political Crossfire: Subsidies and the Shutdown
The ACA marketplace has become a central issue in the ongoing federal budget impasse.
Democrats want to extend the enhanced tax credits to prevent millions from losing affordable coverage.
Republicans have proposed a “clean” continuing resolution to reopen the government first, deferring subsidy discussions until later.
Meanwhile, CMS has announced it will recall furloughed employees to ensure open enrollment runs smoothly—highlighting just how intertwined healthcare access and federal operations have become.
What This Means for Consumers
Beginning Monday, Americans can “window shop” plans on HealthCare.gov to preview rates before open enrollment begins.
For many families, monthly premiums could rise by hundreds of dollars, particularly for those not eligible for subsidies. Without congressional action, millions of middle-income households could once again be priced out of comprehensive coverage.
How Employers Can Respond: Creative Benefit Strategies with SHN
With 2026 shaping up to be one of the most expensive years for health benefits in a decade, strategic planning is critical. SHN’s experts can help employers reassess their funding models, evaluate market alternatives, and ensure every healthcare dollar is spent efficiently.
The Bottom Line
The ACA’s affordability challenges are resurfacing at a time of political gridlock and economic uncertainty. While Washington debates subsidies and shutdowns, businesses and families need real solutions to manage rising costs.
Partnering with experienced consultants—like SHN—can make all the difference in maintaining quality coverage without breaking the budget.