Private health insurance premiums are set to climb in 2026 — in some cases sharply.
Congress remains stalled on health care reform, with partisan disputes over the Affordable Care Act (ACA) Marketplace contributing to the November government shutdown. The central debate is whether to extend the enhanced premium tax credits that have kept coverage affordable for millions.
If those credits expire as scheduled in 2026, the Urban Foundation estimates that 7.3 million people will lose their subsidies, and about 4.8 million could become uninsured. Those who remain insured through the Marketplace could see premiums rise by an average of 114%, according to KFF.
Going without coverage can lead to severe financial hardship. While many workers get insurance through employers, millions — including gig workers, freelancers, early retirees and employees without benefits — must buy their own plans.
The outlook is grim. Experts say higher prices are almost certain next year. But consumers still have ways to manage costs. Here’s what is driving the increases, the coverage options available, and how to choose the plan that fits your needs.
Why Health Insurance Costs Are Rising
ACA Marketplace premiums will spike in 2026 for two main reasons: rising health care costs and the scheduled end of enhanced premium tax credits.
Medical inflation is pushing insurers to raise rates. Hospital costs have increased, the use of expensive GLP-1 drugs like Wegovy and Zepbound is growing rapidly, and potential tariffs add more pressure.
But the biggest financial shock comes from the loss of enhanced ACA tax credits. Introduced during the pandemic in 2021 and extended to 2025 through the Inflation Reduction Act, these credits expanded eligibility for financial assistance. Once they expire, some enrollees will lose subsidies entirely while others will see smaller credits.
Start With a Personal Assessment
If you plan to buy private coverage in 2026, begin by confirming your current plan won’t auto-renew, says Rafael Espinal of the Freelancers Union. That gives you time to compare plans before higher rates lock in.
Next, evaluate your health needs and budget. Every plan requires a trade-off: lower premiums with higher out-of-pocket costs, or higher premiums with more robust coverage. Your decision should reflect your medical usage and financial situation.
Consider the following questions:
How often do you or your family access care? Reviewing your past few years of medical spending can help you estimate future costs.
Do you manage a chronic condition or disability? If you regularly use medical services, paying more for a plan with a lower maximum out-of-pocket (MOOP) may save money.
Could you handle unexpected medical bills? Even with insurance, unexpected costs occur. Some hospitals offer charity care or zero-interest payment plans.
One of the best ways to navigate these choices is to work with an ACA-registered insurance broker, says patient advocate Kristin Happ. Brokers are free to consumers and can match plans to your medical usage. Use the Marketplace’s “Find Local Help” tool or ask for referrals.
Your Private Health Insurance Options
The Good, the Bad and the Risky
ACA Marketplace Plans: The Most Reliable Option
For most people, ACA Marketplace plans remain the safest choice. These plans offer subsidies for eligible households and include key consumer protections: coverage for essential services, free preventive care, no lifetime limits, and protections for pre-existing conditions.
Healthcare.gov allows you to compare plan tiers and estimate total costs based on income and family size.
Tip: You can insure household members on separate plans if it lowers costs.
Other Coverage Options
While the Marketplace is simplest, other options may work better for people who don’t qualify for subsidies. Each comes with trade-offs.
Cash Pay or “Self-Insurance”
Paying out of pocket for all medical care can sometimes be cheaper for routine services. A Johns Hopkins study found cash prices were lower than insurer-negotiated prices for nearly half of common procedures.
But cash pay is risky. Large expenses — such as cancer treatment, which averages $150,000 — can be financially devastating.
“Catastrophic” Plans
These plans offer limited coverage and high deductibles but protect against medical bankruptcy.
You may qualify if you:
- Are under 30, or
- Don’t qualify for premium subsidies, or
- Would face hardship because the cheapest Bronze plan exceeds a set percentage of your income.
Direct Primary Care and Concierge Medicine
These subscription-based models offer unlimited primary care for a monthly fee. They are not insurance and work best when paired with a high-deductible plan. They may not support complex medical needs or specialty referrals.
Professional Group Plans
Some unions and professional associations offer group plans that may cost less. The Writers Guild of America offers comprehensive coverage for eligible members. The Freelancers Union partners with Solo Health and Opolis to create affordable group options for independent workers.
Gig Worker Health Options
Gig platforms like Uber, Lyft, DoorDash and Amazon Flex partner with Stride Health to help workers enroll in ACA plans. California drivers may also qualify for health stipends under Proposition 22.
Hour-based products like UnitedHealthcare FlexWorkⓇ offer targeted coverage, but confirm plans are ACA-compliant.
Non-ACA-Compliant Plans: Use Caution
These plans often lack protections and may exclude pre-existing conditions.
Common types include:
Fixed indemnity and limited benefit plans: Pay fixed amounts for certain conditions, not full coverage.
Short-term plans: Temporary, usually non-compliant and limited in scope.
Off-marketplace private plans: Often require underwriting and may impose coverage exclusions.
Healthshares
Health care sharing ministries are cooperative cost-sharing programs, often faith-based. They aren’t insurance and don’t guarantee payment. Some have faced bankruptcy or allegations of unpaid claims.
Medical Tourism
Seeking care abroad can reduce costs but comes with risks. Vet providers carefully, plan for travel and recovery, and consider follow-up care needs.
Dental and Prescription Savings
Affordable options for dental care include dental tourism and domestic dental school clinics.
Prescription savings tools include:
- Manufacturer savings cards
- Mark Cuban’s Cost Plus Drugs
- Copay assistance programs
- GoodRX (noting past privacy violations)
- Retailers like Costco for bulk savings
The Bottom Line
Choosing private health coverage often feels like picking the least expensive of many difficult options. Understanding the landscape and your own needs can help, but meaningful relief requires policy change.
Some people will be priced out entirely, says patient advocate Victoria Killian. She encourages consumers to contact their elected officials.
“That’s the only way things get changed,” she says. “Lawmakers need to hear how these policies affect your daily life.”
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