Why health insurance premiums are rising in 2026

1. Subsidy changes moved the number you actually pay

For many households the sticker premium moved less than the net premium. When enhanced premium tax credits tighten, the same plan costs more out of pocket even if the carrier barely raised its rate. Households just above the old subsidy cliff feel this most.

2. People are using more care

Deferred care from earlier years worked its way back into claims: more elective procedures, more behavioral health visits, more imaging. Carriers price next year off last year's claims, so a heavy utilization year shows up as next January's rate increase.

3. Specialty and GLP-1 drug spending

A small share of members drives a large share of pharmacy spend. Widespread GLP-1 coverage in particular has been one of the largest single line-item increases in carrier filings, and it's why some plans added step therapy or dropped coverage for those drugs entirely.

4. Risk-pool shifts

When premiums rise, the healthiest members are the first to drop out or move to bronze. The remaining pool is sicker on average, which pushes next year's rate up again. This feedback loop is why individual-market rates rarely rise gently.

What actually offsets the increase

1. Re-verify your income estimate. Subsidies are recalculated on the number you report — an outdated estimate is the most common cause of overpaying.
2. Don't auto-renew. The benchmark plan in your county changes almost every year; last year's best plan is frequently this year's worst value.
3. Re-check the tier. If your income fell under 250% FPL, silver with cost-sharing reductions likely beats whatever you have now.
4. Confirm your drugs are still on formulary. Formulary changes at renewal are quiet and expensive.
5. Compare off-exchange too if you don't qualify for a subsidy — private PPOs sometimes price better at higher incomes.

Rate increases are outside your control. Which plan you're sitting in when they hit is not.