Average premiums in the Affordable Care Act (ACA) individual marketplace jumped an average of 18% from 2025 to 2026, or roughly $79 per member per month (PMPM), according to a new report by Milliman. The report, commissioned by Consumers for Quality Care, found that the increase was driven mainly by the expiration of enhanced premium tax credits, also known as ePTCs. 

How Expiring ePTCs Drove ACA Premiums Higher

The enhanced premium tax credits allowed consumers to pay a discounted rate for qualifying health plans in the ACA marketplace. But their expiration not only increased the amount that people would have to pay out-of-pocket for their plans; it also pushed premiums themselves significantly higher. According to the report, here’s how it happened: 

• When Congress allowed the ePTCs to expire, insurers anticipated that healthier consumers would likely forgo coverage or downgrade their plans instead of paying more out-of-pocket for their premiums. This was expected to tilt the risk pools for ACA plans toward sicker consumers, causing the average cost of coverage to increase. 
• Those expectations did appear to come true: By February 2026, 3 million enrollees – or 15% – had left their ACA marketplace.¹ This expected change to the risk pool alone caused ACA premiums to rise by roughly $47 per month. 

Other Causes of Rising ACA Premiums

Other factors also contributed to the rise of ACA premiums, according to Milliman’s study. 

• Medical costs were the second largest driver of ACA premium hikes. These costs, which include what hospitals and other providers charge for care, contributed roughly $17 of the overall $79/month premium increase.  
• Administrative costs, insurer profit margins and pharmacy costs contributed far less – at  $5, $4 and $2 respectively – to rising premium costs. 

The Fallout

Plans are making up for changes in risk pool and growing healthcare costs by raising premiums across the board. 

• In 2026, average maximum out-of-pocket limits increased from $5,660 to $6,255, meaning that families buying coverage on the ACA marketplace are paying more to receive less or equal coverage. 
• Rising healthcare costs, and the elimination of ePTCs mean that patients must make the difficult decision of paying more for the same coverage or forgoing comprehensive plans in favor of cheaper, leaner ones altogether.

Growing healthcare costs are squeezing American patients. 

• During open enrollment, consumers may expect that plans with higher premiums will cover more, but this is not always the case. Rising healthcare costs, regulatory changes, and complex coverage options mean that patients must navigate a convoluted environment when renewing or switching coverage. 
• Consumers must be sure to check the full picture: your monthly premium, deductible, maximum out-of-pocket limit, and whether your doctors are still in network. A familiar plan may cost you more in 2027.

Read the full report.

1.  Kekatos, M., & Schulze, E. (June 29, 2026). About 3 million fewer people are enrolled under ACA compared to last year: Report. ABC News. Retrieved October 15, 2026, from https://ingest.abcnews.com/Health/3-million-fewer-people-enrolled-aca-compared-year/story?id=134304114 ↩︎