For years, analysts warned that the enhanced Affordable Care Act (ACA) premium subsidies, which were temporarily extended during the COVID-19 pandemic, masked the true cost trajectory of the individual market. This fall, that warning has become reality. The 2026 open enrollment window (Nov 1 – Jan 15, with a deadline of December 15 for coverage… Read More » Author information Ben King Assistant Professor at University of Houston, Tilman J Fertitta Family College of Medicine Ben King is an Editor for the Medical Care Blog. He is an epidemiologist by training and an Assistant Professor at the University of Houston's Tilman J Fertitta Family College of Medicine, in the Departments of Health Systems and Population Health Sciences & Behavioral and Social Sciences. He is also a statistician in the UH Humana Integrated Health Systems Sciences Institute at UH, a Scientific Advisor to the Environmental Protection Agency, and the President of Methods & Results, a research consulting service. His own research is often focused on the intersection between poverty, housing, & health. Other interests include neuro-emergencies, diagnostics, and a bunch of meta-topics like measurement validation & replication studies. For what it's worth he has degrees in neuroscience, community health management, and epidemiology. | LinkedIn | The post Upcoming Premium Spikes in 2026: The Crisis Everyone Saw Coming appeared first on The Medical Care Blog.
For years, analysts warned that the enhanced Affordable Care Act (ACA) premium subsidies, which were temporarily extended during the COVID-19 pandemic, masked the true cost trajectory of the individual market. This fall, that warning has become reality. The 2026 open enrollment window (Nov 1 – Jan 15, with a deadline of December 15 for coverage to start on January 1) is now underway, and for the first time enrollees can see the significant premium hikes expected come January. Many are shocked; many are discouraged.
And this moment did not arrive quietly. The stalemate in Congress that prolonged the most recent government shutdown was driven in part by an effort to secure an extension of ACA subsidy enhancements that have kept out-of-pocket premium costs historically low. As negotiations failed, it became clear that millions of Americans will soon face premiums that rise far faster than wages or inflation.
According to NPR, average benchmark premiums will rise an estimated 26 percent in 2026, with some markets seeing substantially higher increases depending on plan structure, geography, and insurer participation. Kaiser Family Foundation (KFF) analysts note that while list prices are rising by roughly a quarter, actual costs to consumers may spike even more sharply because the tax credit enhancements are expiring and the subsidy formula will revert to pre-pandemic levels.
For some families, particularly those just above the subsidy cutoff, the impact is catastrophic.
This moment requires clear communication. It provides a sober reminder that the affordability crisis is not the result of patient behavior but of policy design and market structure.
What Health Services Researchers and Policy Analysts Should Understand
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Underlying medical costs are rising, but subsidies and politics shape the real story
Insurer filings show that the premium surge reflects increases in medical trend, pharmaceutical spending, labor costs, and delayed care utilization. But the far more consequential shift is the disappearance of enhanced federal subsidies.
The Center on Budget and Policy Priorities (CBPP) warns that as the subsidy enhancements expire, millions could be priced out of coverage, with some families seeing monthly premiums increase by hundreds of dollars. The lack of congressional consensus means that no near-term legislative fix is expected. All this means that, when they unfold, the 2026 premium shocks will largely be a function of policy failure, not actuarial surprise.
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Market churn is likely
And it’s worth monitoring as an indicator of destabilization. Early enrollment data show unusual shopping behavior and higher rates of “downgrading” to lower-tier plans or narrower networks as consumers try to contain costs.
A destabilizing marketplace creates patterns that show how people adapt when coverage becomes too expensive. One early sign is bronze-to-silver or silver-to-bronze migration. This describes people switching metal tiers to manage cost. Bronze plans have lower premiums but much higher deductibles. Silver plans cost more each month but offer better cost-sharing and, for eligible people, cost-sharing reductions. A surge in movement from silver to bronze suggests people cannot afford monthly premiums. Movement from bronze to silver may show that some people expect higher medical needs and cannot risk large deductibles. Large shifts in either direction reveal instability and stress in the market.
Other signals appear as people delay enrollment until the final weeks. Late enrollment often reflects financial strain or confusion about plan options. Rising numbers of people dropping coverage entirely—especially those not eligible for subsidies—indicate that premiums have pushed them out of the market.
We also see increases in medical debt and underinsurance, where people technically have coverage but cannot afford to use it. These indicators, taken together, show how households cope when affordability collapses. They help analysts understand the pressure points in a mandate-free system that leaves consumers few protections against sharp price swings.
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Supplemental insurance will become increasingly relevant—especially for Medicare beneficiaries
Medicare beneficiaries will face their own premium increases in 2026, including higher Part B and Part D premiums. Coverage gaps are pushing more older adults to consider supplemental plans (Medigap), which may buffer some costs but introduce new affordability challenges.
Economists and policy analysts should expect more people to enroll in supplemental plans as premiums rise. Many older adults already struggle with higher Medicare Part B and Part D costs. Mixed Medicare and ACA households will feel pressure on both sides of the market. These families often face two sets of premiums, two deductibles, and different cost-sharing rules. Higher out-of-pocket costs will also change how people manage chronic disease. Patients may delay routine visits, skip lab work, or reduce their medication use when costs rise. These changes harm long-term health and increase preventable complications.
The shift toward supplemental plans deserves strong critique. These plans often raise costs while offering limited value. Many plans have rising premiums that outpace inflation. People who try to switch plans face medical underwriting that can deny coverage or raise prices. Others discover that the plan is not standalone and requires a primary policy they cannot afford.
Supplemental coverage piles complexity onto an already complex system. It shifts the cost-sharing burden to households that already face financial stress. This trend undermines affordability and exposes the failures of a fragmented coverage model that tries to patch gaps rather than fix them.
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Expect measurable impacts on access, utilization, and inequities
As premiums spike, we should expect to see dramatic effects on access, health, and the stability of the health system. Already, large numbers of Americans report delaying or forgoing care because of cost. In 2023, more than one in four adults said they postponed or skipped medical, dental, or mental-health care due to cost concerns.
When insurance becomes unaffordable, many people, especially low-income workers, will delay checkups, skip preventive care, or skip needed treatment. Evidence shows that people who go uninsured even briefly are far less likely to receive preventive services or chronic disease management. For patients with chronic illness, rising premiums will likely mean cutbacks on medication adherence, follow-up visits, or specialist referrals. Over time, that will worsen health outcomes and raise long-term costs across the system.
We should also expect widening inequities and growing strain on safety-net providers. Lower-income households and racial or ethnic minority groups already report disproportionately high difficulty affording care. As premiums rise, these groups will feel the pinch most severely. Many may lose coverage or avoid care entirely. That dynamic will deepen existing disparities in access, chronic disease outcomes, and preventive care.
Meanwhile, community health centers, hospital systems, and other safety-net providers will see surges in uninsured or underinsured visits. Research on rising premiums and cost-sharing shows that increased financial burden leads directly to heavier use of uncompensated care, emergency departments, and safety-net resources. This growing uninsured burden may destabilize providers in under-resourced communities and reduce the overall capacity of the health care system.
For policymakers and analysts, 2026 will be the most consequential enrollment year since the ACA marketplaces launched.
Guidance for People Making Decisions Right Now
If you are logging into HealthCare.gov this week and seeing premium increases that feel overwhelming—you’re not alone. Consumers across the country are experiencing the same shock. A few things to keep in mind:
- Shop carefully: plans may differ dramatically this year
Do not auto-renew. Insurers have substantially changed deductibles, networks, and premiums.
- Check whether you still qualify for subsidies
Even though enhancements expired, many people—especially those with fluctuating incomes—still qualify for baseline ACA subsidies.
- Look at total yearly cost, not just the monthly premium
A cheaper premium may come with a deductible or coinsurance structure that ultimately costs more.
- If you are near Medicare eligibility, review supplemental options
Part B, D, and Medigap costs are rising; evaluate your options early.
- If you lose coverage or cannot afford your plan, seek help immediately
Local navigators, community health centers, and nonprofit enrollment assisters can identify options such as:
- Medicaid (for eligible households)
- Special enrollment periods
- Community health center sliding-scale services
You don’t need to navigate this alone.
Premiums Are Rising. But They DON’T HAVE TO.
The 2026 premium spike is not an inevitability of healthcare economics. It is the result of policy choices, or more precisely, a failure to sustain policy mechanisms that kept care affordable. Patients should not bear the cost of congressional deadlock, and providers should not absorb the downstream strain.
For researchers, policymakers, clinicians, and advocates, this moment demands clarity, urgency, and renewed commitment to affordability reforms that match the scale of the problem.
The premium crisis is now here, but its permanence is not predetermined.
Author information
Ben King
Ben King is an Editor for the Medical Care Blog. He is an epidemiologist by training and an Assistant Professor at the University of Houston's Tilman J Fertitta Family College of Medicine, in the Departments of Health Systems and Population Health Sciences & Behavioral and Social Sciences. He is also a statistician in the UH Humana Integrated Health Systems Sciences Institute at UH, a Scientific Advisor to the Environmental Protection Agency, and the President of Methods & Results, a research consulting service.
His own research is often focused on the intersection between poverty, housing, & health. Other interests include neuro-emergencies, diagnostics, and a bunch of meta-topics like measurement validation & replication studies. For what it's worth he has degrees in neuroscience, community health management, and epidemiology.
The post Upcoming Premium Spikes in 2026: The Crisis Everyone Saw Coming appeared first on The Medical Care Blog.
