Premiums on the Affordable Care Act (ACA) health marketplace will increase by an average of 20% nationwide in 2026. The report reviewed official rate filings from all 50 states and Washington, D.C.
Some states will see far larger increases. Premiums rose as much as 67% in certain markets, with the steepest jumps occurring in states that rely only on the federal exchange.
Study used rate filings for 2026 benchmark Silver plans and weighted them by 2024 Census population data. The analysis found that states with Medicaid expansion, state-run marketplaces, or reinsurance programs generally posted smaller and more predictable increases.
“States with active market management consistently show more stability,” said Nathan Paulus, Head of Content at MoneyGeek. “The pattern holds across many policy areas.”
The report coincides with the start of open enrollment for 2026 and comes as Congress debates whether to extend enhanced premium tax credits that expire at the end of 2025.
Large Differences Between States
The national average masks wide differences in state-level changes.
Ten states recorded premium increases above 30%, while eight kept increases below 10%.
The biggest jumps appeared in states without Medicaid expansion or without state-led oversight of their marketplaces.
States With the Largest Increases
Eleven states saw increases of more than 30%. Arkansas experienced the highest jump, rising 67%, which adds about $329 per month for a 40-year-old before subsidies. Arkansas has a limited reinsurance program, but it was not enough to stop the steep climb.
Four of the top 11 states—including Florida and Texas—have not expanded Medicaid.
Most Stable Markets
Five states kept increases under 6%, and three of them operate state-run marketplaces. Alaska was the only state where premiums dropped, falling nearly 3% due to its reinsurance program.
Low growth percentages do not always mean low premiums. Vermont’s 6% increase still results in a $1,223 monthly premium, almost 50% higher than Arkansas’s 2026 premium, even though Arkansas experienced the largest increase. States like Vermont and New York use community rating, which produces higher baseline costs because premiums do not vary by age.
Regional Gaps Are Growing
Premium growth is highest in the South:
| Region | 2025 Avg. | 2026 Avg. | % Change |
|---|---|---|---|
| South | $593 | $766 | +29.2% |
| Midwest | $547 | $654 | +19.5% |
| West | $588 | $682 | +16.1% |
| Northeast | $790 | $864 | +9.3% |
Southern states are less likely to have Medicaid expansion, state-run exchanges, or reinsurance programs, which may contribute to larger increases.
State Policy Choices Matter
We found strong links between state policy decisions and premium growth:
Medicaid expansion states had growth 8 points lower than non-expansion states (20.2% vs. 28.0%).
State-run marketplaces had increases 5 points lower than states on the federal exchange (18.6% vs. 23.6%).
Reinsurance programs were associated with 4 points lower premium growth (19.2% vs. 23.3%).
These findings show correlations, not proof of cause, but the patterns were consistent across all major policy areas. States that combined all three policies—Medicaid expansion, reinsurance, and a state-run marketplace—had the most stable premiums.
Nine states still have not expanded Medicaid. Eight of them saw above-average premium increases.
Impact on Consumers
About 92% of marketplace enrollees receive subsidies, which shield them from most of the premium increases. But unsubsidized consumers—roughly 8% of marketplace participants, often early retirees or self-employed adults—face the full cost of rising premiums.
Higher premiums do not guarantee better coverage. that insurers still deny 1 in 5 claims, leaving many consumers with unexpected bills.
A major factor looming over the 2026 market is the possible expiration of enhanced federal subsidies on December 31, 2025. The Congressional Budget Office warns that without an extension, the number of uninsured Americans could rise by 3.8 million each year from 2026 to 2034.
Unsubsidized consumers—about 2.4 million people nationwide—would face the greatest financial burden as gross premiums climb.
Related topics
Lilly Medicine Company Secures Approval For New Alzheimer’s Treatment
New Dental Plans Initiative Helps Dentists Spot Cardiovascular Disease Risks
Providence Cuts Jobs As Health Insurance Plans Face Financial Strain
