As millions of Americans shop for health care coverage during 2026 open enrollment, Affordable Care Act Marketplace premiums have increased by about 20% nationally year over year, according to an updated population-weighted analysis released Thursday by MoneyGeek, a personal finance website.
Rate filings for 2026 show substantial variations across the 50 states. Health insurance premiums in 10 states increased by more than 30%, while eight states raised theirs by less than 10%.
The statistical analysis shows consistent associations between state policy interventions and lower premium growth:
- Medicaid expansion states posted about 8 percentage points lower growth than non-expansion states;
- State-run marketplaces saw 5 points lower increases compared with states that use the federal Healthcare.gov platform; and
- Reinsurance programs correlate with 4 points lower growth.
These associations are correlational, not causal, MoneyGeek said. But the direction and consistency of effects across policy dimensions suggest that state interventions can moderate premium volatility.
States that combine Medicaid expansion, reinsurance and a state-run marketplace reported the most stable premiums nationwide, holding average increases to the low-teens range. Of the nine states than have not expanded Medicaid, eight saw above-average premium growth.
Nine in 10 ACA enrollees receive federal subsidies that reduce out-of-pocket costs, but these are set to expire Dec. 31. Congress is debating whether to extend enhanced premium tax credits.
Without a permanent extension, the number of uninsured people will increase by 3.8 million on average each year from 2026 to 2034, according to Congressional Budget Office estimates.
MoneyGeek’s report is based on an analysis of ACA Marketplace premiums for 2025 and 2026, using official rate filings from all 50 states and the District of Columbia. Researchers focused on individual-market Silver-tier plans for a 40-year-old adult, the federal benchmark for comparing premiums across states.
They sourced rates for Federally Facilitated Marketplace states came from the Centers for Medicare & Medicaid Services QHP Landscape and Rate Public Use Files. Data for State-Based Marketplaces came from state marketplace filings or, if unavailable, were collected directly by MoneyGeek.
Researchers verified marketplace classifications, Medicaid expansion status and reinsurance program designations through CMS and Kaiser Family Foundation databases.
See the accompanying gallery for the 10 states with the largest increase in health care premiums for 2026.
(Credit: Adobe Stock)
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