August 6, 2025

Insurers seek 18% ACA premium hikes as subsidies expire

Profits up 41% while insurers seek 18% premium increases

🏥Public Health💰Economy

A Peterson-KFF analysis of 2026 initial rate filings finds a median proposed ACA Marketplace premium increase of 18% for 2026.

Insurer filings and KFF's review show insurers expect roughly a 4 percentage point additional increase in rates because the enhanced premium tax credits are scheduled to expire on Dec. 31, 2025.

Multiple insurer filings cite specialty drugs, including GLP-1 diabetes and weight-loss medications, as a material driver. One insurer projected utilization and script mix would rise 18% in 2025 and 7% in 2026.

Several insurers explicitly built an estimated ~3 percentage points into rate requests to reflect potential tariffs on imported pharmaceuticals and medical supplies.

KFF's modeling indicates that for the 22.8 million people enrolled in 2026 Marketplace plans, subsidized enrollees would pay substantially more if enhanced credits expire, with average premium payments rising by more than 75% for those currently receiving enhanced credits.

Specific claims about combined insurer profits and exact CEO compensation require company SEC filings and audited financials; those figures were not verified by the materials reviewed here. (See sources for earnings reporting.)

State insurance regulators have statutory authority to review and reject excessive rate requests, and insurers have said they may challenge denials in court; the legal claims and outcomes vary by case and are not resolved uniformly across states.

🏥Public Health💰Economy

Test Your Knowledge

True or False: CVS Health owns both an insurance company AND a pharmacy benefit manager.

How many Americans will lose coverage when enhanced subsidies expire?

What's the median ACA premium increase insurers requested for 2026?

True or False: Most ACA marketplace plans cover GLP-1 drugs like Wegovy for weight loss.

Arrange these ACA subsidy policy changes in order - watch the setup for collapse.

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People, bills, and sources

Andrew Witty

UnitedHealth Group CEO

Gail Boudreaux

Elevance Health CEO

Karen Lynch

CVS Health CEO

Jessica Altman

California Insurance Commissioner

Cynthia Cox

KFF Vice President

Donald Trump

Former President

Xavier Becerra

HHS Secretary

What you can do

civic action

File public comments opposing 18% ACA premium increases before state insurance commission deadlines

Submit a public comment on your state insurance commission's rate review docket before the comment deadline.

Key points to include in your public comment to your state insurance department:

Opening statement: I am writing to oppose the proposed 18% median premium increase for 2026 ACA Marketplace plans.

Data points to mention:

Insurers are requesting a median 18% increase in premiums for 2026
About 4 percentage points of this reflects the expected expiration of enhanced premium tax credits on Dec. 31, 2025
Some insurers cite rising GLP-1 drug utilization, with one projecting 18% increase in 2025 and 7% in 2026
Insurers built roughly 3 percentage points into rates to cover potential tariffs
KFF modeling shows subsidized enrollees' average premium payments would rise more than 75% if enhanced credits lapse

Impact explanation: These rate increases will make health insurance unaffordable for many families, especially if enhanced subsidies expire. The combination of premium hikes and subsidy expiration could force thousands of people to drop coverage. This affects real people who depend on Marketplace plans for essential healthcare.

Questions to ask:

What specific steps will you take to review these rate requests?
Will you require insurers to justify each component of the increase?
How will you ensure transparency in the rate review process?

Specific request: I urge you to reject or significantly reduce these rate increase requests. Please require detailed justification for each component and ensure the process is transparent and accessible to the public.

Thank you for considering my comment.

www.naic.org/state-insurance-departments

understanding

Check your subsidy eligibility

Use or your state exchange to estimate subsidies and plan options during Open Enrollment.

practicing

Document claim denials

Keep records of denials and appeals for potential administrative complaints or bad-faith litigation.

Use state page

civic action

Advocate for stronger rate review rules

Support legislation requiring approval for rate increases above a fixed threshold and greater public disclosure of insurer rate models.

Subject: Support Stronger Insurance Rate Review Legislation

Dear [State Legislator Name],

I'm writing as a constituent to urge you to support legislation requiring stronger rate review rules for health insurance companies.

Key facts:

Insurers are requesting a median 18% premium increase for 2026 ACA Marketplace plans
About 4 percentage points reflect the expected expiration of enhanced tax credits on Dec. 31, 2025
Some insurers cite rising drug costs, with one projecting 18% increase in GLP-1 drug utilization in 2025
Insurers built roughly 3 percentage points into rates for potential tariffs
KFF modeling shows subsidized enrollees could see more than 75% increase in premium payments if enhanced credits expire

Impact on constituents: When insurance companies can request large rate increases without strong oversight, families lose access to affordable healthcare. Without stronger rate review rules, insurers can pass costs onto consumers without sufficient justification. This affects thousands of families in our state who depend on Marketplace plans.