Using public rate filings, Milliman broke down the 2026 healthcare premium increases. Key findings include:

• The end of enhanced subsidies was the biggest factor in increasing premiums. About $47 of the $79 monthly increase came from insurers expecting a sicker group of enrollees. Milliman found that this shift can largely be explained by the exiting of healthier members from the ACA market driven by the expiration of enhanced tax credits.
• Rising healthcare costs contributed to higher premiums, but not all healthcare costs have the same impact.
  • Rising medical costs were the next-largest driver of year-over-year growth – the cost of hospital and other medical care added $17 per member per month. 
  • Pharmacy costs added $2 to the cost increase.
• Coverage got leaner, and the average maximum out-of-pocket limit rose from $5,660 in 2025 to $6,255 in 2026.
• Plan expenses also pushed premiums up. Administrative expenses added $5 per member per month, insurer margin added $4, and taxes and fees added $1. Other claims-related adjustments added $3.

As open enrollment approaches here’s what consumers need to know before renewing:

CQC urges consumers not to assume that a plan costing roughly what they paid in 2025 or last year will provide the same coverage in 2027. Before renewing, check:  

1. Your monthly premium and whether you qualify for financial help.
2. Your deductible and maximum out-of-pocket limit.
3. Whether your doctors are still in network.

Open enrollment is the time to really pay attention. Consumers should review their plan carefully rather than assuming your previous plan will still be the best fit. This year, a familiar plan might come with an unfamiliar price tag.

Consumers should not have to decode a complicated insurance filing to understand why your health care costs are going up. CQC is focused on making those changes clear and giving consumers information they can use.