On October 29, the federal health insurance marketplace website, healthcare.gov, posted the health insurance rates for exchange-based health (Affordable Care Act, or ACA) coverage in 2026. Open enrollment for exchange-based insurance started November 1. Open enrollment runs through January 15, 2026.

The rates are about 26 percent higher than last year, based on analysis of the rates for the mid-range (price and benefits provided) silver plan. It is these silver plan rates that are the benchmark against which the premium tax credits (PTCs)—both with enhancements which will expire December 31 unless Congress intervenes, and for the PTCs if the enhancements are not extended)—are calculated.

The increase will go as high as 114 percent, on average, if the PTCs are not extended, said KFF, a health research nonprofit. But, the Centers for Medicare and Medicaid Services (CMS) said in an October 28 press release that healthcare.gov enrollees will be able to buy “bronze” health insurance (a lower level of coverage with higher deductibles and copays) for “no more than $50/month.”

The ACA requires large employers (those with 50 or more full-time equivalent employees) to make “shared responsibility payments” if they do not offer affordable health insurance to their employees if any of their employees qualify for the PTCs. Thus, the affordability of health coverage, whether on the private market or through an ACA exchange, is a crucial factor in an employer’s decision to provide coverage (at an affordable rate) to their workers, or instead to let them get their own coverage (with or without employer assistance) and instead pay the shared responsibility assessment.

Prospects: These initial rates will vary state by state, depending, among other things, on whether the state has its own exchange or uses the federal exchange. But all indications are that health insurance rates are poised to skyrocket, regardless of the source of the coverage. It was at the heart of the Democrats demands in the government shutdown debate, and will continue to be a top priority as lawmakers move to fund the government for all of FY 2026.. Many Republicans oppose extending the enhancement to the PTCs, but indications are that a significant number would support at least a short-term, possibly modified extension of them.

NAIFA Staff Contact: Mike Hedge – Senior Director – Government Relations, at mhedge@naifa.org.