Premium increases are always a major factor for clients—especially for those who currently pay little or nothing for their ACA coverage. Looking ahead, 2026 may bring one of the largest premium increases in recent history. These changes are being driven by three key factors:
1. Carrier Rate Hikes for Unsubsidized Premiums
Carriers have already submitted their proposed rate increases to CMS. As of now, the expected weighted average increase for unsubsidized enrollees is about 23.4% nationally—the largest year-over-year ACA increase since 2014.
Some states will see even higher jumps. For example, Mississippi could face average increases of 36.8%.
Justifications vary by state and carrier, but common reasons include:
The upcoming expiration of eAPTC (see below)
Rising medical service costs
Changes in morbidity levels
Legislative changes (such as STM and Association Health Plans) drawing healthier enrollees out of the ACA market
While subsidies will help some clients absorb these increases, the higher baseline rates will still be significant.
2. Premium Adjustment Percentage Index (PAPI) Changes
The Premium Adjustment Percentage Index (PAPI), set by the IRS, determines how much of their household income ACA consumers must contribute to premiums. For 2026, the formula is changing dramatically:
A household at 200% FPL will go from paying 2% of income today to 6.6% in 2026 (a threefold increase).
A household at 150% FPL will go from 0% today to 4.19% in 2026.
Even the lowest-income households (<133% FPL) will pay up to 2.10% of their income.
These shifts are based on benchmark silver plans. While some $0 options may remain in 2026 (likely bronze), $0 silver plans will no longer be widely available.
3. Expiration of Enhanced APTC (eAPTC)
The American Rescue Plan Act (ARPA) and later the Inflation Reduction Act (IRA) expanded ACA subsidies and removed the “subsidy cliff” at 400% FPL. Unless Congress extends these provisions, the expanded subsidies will expire at the end of 2025.
If they do expire, consumers across the income spectrum will feel the impact—especially higher-income enrollees who may have to pay full price.
Examples if eAPTC expires:
A 64-year-old couple in Florida earning $90K (~440% FPL) would see their benchmark silver premium rise from $637/month in 2025 to $3,000/month in 2026—a 4.7x increase.
A 50-year-old in Texas earning $70K (~465% FPL) would see their premium nearly double, from $496 to $960/month.
What This Means for Your Clients
The groups most likely to feel sticker shock in 2026 are:
Low-income consumers, who may lose access to $0 premiums
Higher-income consumers, who could face full-price plans for the first time in years
It will be crucial to prepare these clients ahead of Open Enrollment, explain the potential changes, and explore every available option.
Act Now: Affordable Coverage Options Beyond ACA
For your high-income consumers, you may find that ACA plans are no longer the best choice at the new price point. While some may need to stay with ACA due to networks or pre-existing conditions, healthy consumers should explore other options that can satisfy their insurance needs while costing less than a full-price ACA plan.
Fortunately, O’Neill Marketing has you covered with off-market major medical plans that are an excellent fit for these consumers. Options include:
AFI PPO Plans (Cigna PPO Network): Robust national network access, predictable benefits, and cost savings compared to unsubsidized ACA coverage.
Deductible Value Plans (First Health PPO): A solid balance between lower premiums and coverage.
Maximum Value Plans (Cigna PPO): Comprehensive protection with strong network access.
These choices give you the flexibility to match clients with the right plan design for their health needs and budget.
In addition, O’Neill Marketing offers supplemental and ancillary solutions such as:
Gap coverage
Accident and critical illness plans
Hospital indemnity options
These combinations allow you to tailor coverage while keeping premiums under control and providing financial protection beyond medical expenses.
Final Thoughts
With so many changes on the horizon, early communication will be key. By starting these conversations now, you can help clients avoid surprises, evaluate their options, and find the plan that works best for their needs.
At O’Neill Marketing, we’re here to support you every step of the way with the tools, products, and guidance to help your clients navigate 2026 successfully.
