ACA plans and rate increases - projected WPost article
Karen Kierpaul
Average Obamacare premiums are set to rise 30 percent, documents show
The higher prices — affecting up to 17 million Americans who buy coverage on Healthcare.gov — reflect the largest annual premium increases by far in recent years.
Premiums for the most popular types of plans sold on the federal health insurance marketplace Healthcare.gov will spike on average by 30 percent next year, according to final rates approved by the Centers for Medicare and Medicaid Services and shown in documents reviewed by The Washington Post.
The higher prices — affecting up to 17 million Americans who buy coverage on the federal marketplace — reflect the largest annual premium increases by far in recent years. The higher premiums, along with the likely expiration of pandemic-era subsidies, mean millions of people will see their health insurance payments double or even triple in 2026.
The premium spikes, mirroring the rising cost of private-employer-sponsored plans, arrive during a protracted and bitter congressional battle over health insurance costs that prompted a government shutdown Oct. 1. Democrats have urged an extension of enhanced subsidies for plans sold through the Affordable Care Act to soften the blow of rising insurance costs, while Republicans have said the additional assistance was never meant to be permanent.
The spike in premiums will become visible to more Americans on Monday, when the Trump administration is expected to open Healthcare.gov for window shopping to browse the price of plans ahead of the Nov. 1 start to open enrollment.
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Under the Affordable Care Act, Americans can buy insurance plans through government websites and receive federal assistance to pay for their premiums based on their income. Even after the extra subsidies expire at the end of the year, a majority of marketplace enrollees will still be eligible for assistance to lower their monthly premium costs.
CMS spokesman Christopher Krepich said the average ACA enrollee will be able to access a health plan for less than $50 a month after receiving subsidies “despite doomsday Democrat fearmongering and the Biden administration’s gross mismanagement of the ACA marketplaces.”
“The administration will continue to take action to stabilize the ACA market and deliver cost savings for the American people,” he said, citing recent White House announcements that pharmaceutical companies pledged to lower some drug prices.
Enhanced subsidies helped Americans in higher income brackets, including small-business owners, afford insurance sold through the law. Those who earn more than 400 percent of the federal poverty level — $72,000 for an individual — will no longer get any subsidies and face much higher monthly payments.
The 30 percent premium increase shown in the documents reviewed by The Post was calculated by looking at average premiums across the country for certain mid-level “silver” plans, used as benchmarks to give an idea of how much premiums are rising. Only the 30 states that use Healthcare.gov to sell insurance plans were included in the calculation, although the state-run marketplaces where an additional 7 million people get coverage are also reporting substantial premium hikes.
Since Affordable Care Act marketplaces launched in 2014, Healthcare.gov premiums have risen higher only one other year, according to tracking by KFF, a nonpartisan health policy research organization. In 2018, average benchmark plans became 37 percent more expensive compared with 2017.
Average benchmark premiums declined every year between 2018 and 2022 and had risen by single digits annually since then. Total enrollment in marketplace plans has more than doubled since 2020, to about 24 million this year. The average monthly premium for a benchmark plan for a 40-year-old individual was $497 this year.
The out-of-pocket increase to consumers could be worse this year than in 2018 because additional federal funding for tax credits that subsidize the costs of the plans is set to expire.
Insurers have cited the looming expiration of extra subsidies as a reason for hiking premiums because they anticipate healthy people dropping coverage if they decide it’s too expensive. Insurers have also cited growing drug and hospital costs and medical inflation as reasons for higher premiums.
Chris Bond, a spokesperson for the health insurance trade association AHIP, said in response to the premium increases that Congress should “act as quickly as possible to extend the health care tax credits.”
Congress approved the extra subsides in 2021 to help more people afford health insurance during the pandemic. About half of all marketplace shoppers paid nothing for their monthly premium, and many higher-income earners received hundreds more in subsidies every month. Extending the extra subsidies would cost $350 billion over a decade, according to the nonpartisan Congressional Budget Office — about 50 percent more than Congress might otherwise spend on subsidies.
Congressional Democrats have refused to vote for a funding bill without extending the extra subsidies to help cushion consumers against the rising costs. Republicans — who have long criticized the 2010 health care law that set up the marketplaces — say the subsidies should either expire or be negotiated at the end of the year.
In contrast to past years, CMS officials don’t plan to release a broad swath of data on marketplace plans, according to a rollout document viewed by The Post. The reports typically include information on how many insurers are participating, how many options consumers have and how much different types of plans cost.
Krepich said that “some broader program information that does not impact anyone’s ability to access care may be delayed,” because of “the Democrats’ decision to shut down our government.”
Michigan submitted plan rates for 2026
SEE attachments below - these rates were submitted to DIFS for review and approval.
