Exchange premiums may rise the most since 2018

Modern Healthcare – Friday, July 18, 2025
By Nona Tepper

Big premium increases could be coming to the health insurance exchanges next year.

Marketplace carriers are seeking a median 15% rate hike for individual and small-group plans in 2026, according to preliminary rate requests health insurance companies filed in 19 states and the District of Columbia. The health policy research organization KFF published an analysis of those filings Friday.

That would represent the largest rise in premiums since 2018, and for similar reasons. The year before, President Donald Trump and the majority-Republican Congress came close to repealing the Affordable Care Act of 2010, leading insurers to raise prices amid uncertainty.

Exchange premium hikes in recent years have been much smaller, the KFF study shows. Average rates rose 7% for the 2025 plan year and 6% the year before. Exchange membership reached a record-high 24.3 million in 2025.

During this rate season, exchange insurers anticipate that Trump and the GOP Congress will allow the enhanced premium tax credits in place since 2021 to expire at the end of 2025. The Centers for Medicare and Medicaid Services also tightened enrollment rules starting next year.

The nonpartisan Congressional Budget Office projects these two changes will cause 5.1 million people to become uninsured starting next year. Exchange members who remain are expected to be relatively sicker and costlier to insure.

Rate requests for 2026 also cite the effects of tariffs on pharmaceuticals, medical devices and other products, spending on glucagon-like peptide-1 agonists for weight loss, provider demands for higher reimbursements, and generally rising healthcare costs as justifications for price increases.

Moreover, the health insurance sector expects exchange enrollment to further diminish, and risk pools to worsen, as provisions from Trump’s “One Big Beautiful Bill” begin to take effect, including $200 billion in exchange spending cuts over a decade.

In addition to unfavorable and uncertain regulatory conditions, problems have emerged in the health insurance exchange market as insurers such as Centene, Molina Healthcare and Elevance Health report excess spending and narrowing profit margins.

The KFF report is based on preliminary rate filings for exchange and off-exchange individual and small-group plans, and includes less than half of states, so the final premiums for 2026 may look different.

State regulators that must approve premium increases generally require insurers to file by July 16 but give them until Aug. 1 to make revisions.

Many health insurance companies submitted requests before Trump enacted the tax-and-spending-cuts law July 4 and some did so before CMS issued its exchanges final rule last month.

Companies such as Cigna, Elevance Health and Molina Healthcare wrote in their rate filings that they may revisit their requests. Centene already retooled its bids.

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