New CQC-commissioned Milliman analysis for Consumers for Quality Care also finds leaner plans and higher out-of-pocket limits in 2026 filings 

WASHINGTON — Average premiums in the Affordable Care Act (ACA) individual market rose roughly 18% from 2025 to 2026, or by almost $1,000 annually for the average ACA plan member. Although several causes contributed to the increase, the biggest cause by far was the morbidity impact due to the expiration of enhanced premium tax credits at the end of 2025, according to a new Milliman analysis commissioned by Consumers for Quality Care (CQC), a coalition of advocates and former policy makers working to provide a voice for patients in the health care debate.

CQC is releasing the report during Health Literacy Month to help consumers understand, before they choose their coverage for 2027, why their bills are likely to be higher as 2027 premium increases are expected to remain similar to 2026. The full report, Drivers of Individual Market ACA Premium Changes in 2026, is available here.

What caused the increase

Using public rate filings, Milliman broke down the 2026 premium increases. Their report found that:

• The end of enhanced subsidies was the biggest factor. 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 medical costs were the next-largest driver Year-over-year growth in medical costs – 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. Benefit designs became slightly less generous, 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 $4, and taxes and fees $1. Other claims-related adjustments added $3.

When the enhanced subsidies expired, many ACA enrollees were faced with a choice. They could reach deeper into their own pockets to pay their premiums, or they could leave the ACA market and find coverage elsewhere or go uninsured. Insurers expected that many healthier people would choose to leave while many sicker people would choose to stay. But this would change the mix of ACA enrollees, skewing it toward more intensive users of healthcare services, causing the average cost of coverage to go up. 

As predicted, roughly 3 million people – or 15% of enrollees – left the ACA market by February 2026, the report notes.¹ This expected shift helped drive premiums 18% higher, representing a monthly increase of roughly $79 per member.

But even the 18% figure represents premium increases before subsidies are applied. Consumers who lost the enhanced tax credits will have seen what they actually pay in premiums rise by even more, although the extent of the increase will have varied by household.

Worse, premiums are expected not only to remain higher but also to continue rising at a rapid pace. Based on early 2027 rate filings, additional premium increases of as much as 14% may be on the horizon, according to a preliminary analysis cited in the report. Although that rate of increase is lower than in 2026, it is still high by historical standards, and the Milliman report states that expired subsidies are expected to remain a factor in 2027 rates. 

“Families who are buying coverage on the ACA marketplace are paying more, and in many cases, they’re getting less for their money,” said Jim Manley, a CQC board member. “The cuts to the enhanced subsidies were the biggest factor, but underlying healthcare costs are rising, too. Hospitals and other medical providers are charging a lot more, and those price increases are also driving premiums higher.”

“Because premiums have increased so much, consumers will have to look beyond each plan’s price tag to gain a sense of how far their coverage will go,” Manley added. “That’s not easy, and I worry that many consumers will struggle to make sense of it all, especially given how complicated health insurance has become these days.”

What to check before renewing

CQC urges consumers not to assume that a plan costing roughly what they paid last year will provide the same coverage in 2027. A plan with similar coverage will likely cost much more. Before renewing, check:  

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

About the analysis

Milliman analyzed the 2025 and 2026 Unified Rate Review Template public use files published by the Centers for Medicare & Medicaid Services. Figures are national averages, and changes for any given plan will differ. The analysis was commissioned by CQC.

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 ↩︎