Some Americans are getting sticker shock as they shop for Affordable Care Act insurance
The Affordable Care Act (ACA) marketplaces opened for enrollment on Nov. 1, with a significant increase in premiums causing concern for many Americans. According to nonprofit health research firm KFF, the average premium for a mid-level insurance plan has surged by 26% this year, reaching $625 per month. This spike in rates is the largest increase since 2018, leading to sticker shock for individuals who rely on the ACA for health insurance coverage.
One such individual is Jeremy Tolbert, a 47-year-old web developer from Lawrence, Kansas. When he logged into his state’s marketplace, he was dismayed to discover that his current plan’s monthly premium is set to rise to $2,600 a month next year, up from $2,200 a month in 2025. The higher costs, including increased cost-sharing for his family, have left Tolbert questioning the value of his insurance coverage.
Approximately 24 million Americans receive their health insurance through an ACA plan. The 26% premium hike for ACA silver plans reflects what insurers are charging consumers purchasing plans through the marketplaces. While millions of Americans currently benefit from premium tax credits, these credits are set to expire at the end of 2025. This deadline has contributed to the ongoing U.S. government shutdown, as Democratic lawmakers advocate for an extension.
KFF estimates that the roughly 22 million people who rely on premium tax credits could see their ACA plan costs more than double in 2026. Those who do not qualify for the credits, like Tolbert, will also face significantly higher health insurance costs next year. The main factors behind these increases include rising demand for expensive treatments, higher prices from healthcare providers, and insurer projections that millions of people may drop their coverage when the tax credits expire.
Cynthia Cox, vice president and director of KFF’s program on the ACA, attributes the premium increases to the overall rise in healthcare costs. She notes that factors such as hospital expenses, doctor visits, and prescription drugs contribute to the escalating premiums. The current situation echoes the premium increases seen in 2017-2018 when discussions surrounding ACA ‘repeal and replace’ were prevalent during the Trump administration.
The prospect of higher ACA insurance costs may lead some individuals to forgo coverage, opting for skimpier plans with higher deductibles. Julie Margetta Morgan, president of The Century Foundation, warns that consumers could face increased out-of-pocket expenses in the coming year. Despite the financial strain, going without health coverage could have serious consequences, as it essentially involves gambling with one’s health and financial stability.
For Tolbert and his family, the rising premiums raise concerns about the affordability of their ACA insurance in the future. If the trend continues, they may be forced to seek employment with larger employers to secure health insurance. Ultimately, the uncertainty surrounding ACA plan costs highlights the importance of ensuring access to affordable healthcare for all Americans.
