Millions Of Americans To Pay 75% Surge In Insurance Premiums Next Year

A perfect storm of rising health care costs, expensive new drugs, and the scheduled end of enhanced federal subsidies could drive Affordable Care Act (ACA) Marketplace premiums to their steepest levels in years—hitting more than 24 million Americans in their wallets, Ashley Lutz reported for Fortune.

Runaway medical costs remain the primary culprit, with hospital services, physician visits, and prescription drugs—especially GLP-1 medications for diabetes and weight loss—driving the trend.

According to an analysis of insurers’ 2026 filings by Peterson-KFF’s Health System Tracker, the median proposed premium increase across 312 marketplace insurers is 18%.

Most hikes range from 12% to 27%, with more than 125 insurers seeking increases of 20% or more—the sharpest climb since 2018. Final rates will be locked in by late summer 2025.

Runaway medical costs remain the primary culprit, with hospital services, physician visits, and prescription drugs—especially GLP-1 medications for diabetes and weight loss—driving the trend.

Insurers report medical inflation of 8% to 10% annually, with some even dropping coverage for weight-loss GLP-1s in an attempt to contain costs.

Layered on top of that is a looming policy shift: the expiration of enhanced premium tax credits enacted in 2021 as part of pandemic relief.

If Congress allows these subsidies to lapse at the end of 2025, monthly out-of-pocket costs for subsidized enrollees are projected to jump roughly 75% on average.

That increase comes in addition to insurers’ base premium hikes.

The subsidy rollback alone explains about 4 percentage points of the proposed 2026 rate hikes, partly because insurers expect healthier customers to drop coverage, leaving behind a riskier pool.

Insurers are also preparing for potential tariffs on medical supplies and pharmaceuticals from U.S. President Donald Trump, which could add about 3 percentage points to premiums.