Health insurance costs are set to increase in many parts of the market in 2026, with some patients facing higher out-of-pocket expenses for doctor visits and changes in prescription coverage. Insurers and employers are struggling with rising prescription prices and medical costs, and these financial pressures are likely to be passed on to consumers next year.
Experts predict the price hikes could be especially steep in individual coverage marketplaces, where insurers are also concerned about potential reductions in federal government support, which currently helps people afford their coverage.
Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation (KFF), said, “We’re in a period of uncertainty in every health insurance market right now, which is something we haven’t seen in a very long time.”
Recent earnings calls from insurers have highlighted a range of rising costs: more people are seeking care, emergency department visits are on the rise, and claims for mental health treatments are increasing. Additionally, fewer healthy individuals are maintaining coverage in the individual market, leaving behind a higher concentration of sicker patients whose claims drive up costs.
While enrollment in the Affordable Care Act (ACA) marketplaces surged in recent years, tightening eligibility verifications and efforts to crack down on fraud—policies that were relaxed during the COVID-19 pandemic—are making it harder for some individuals to maintain coverage. David Windley, an analyst at investment banking firm Jefferies, pointed out that these changes are impacting the number of people able to stay insured.
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