How to Choose Health Insurance When Premiums Rise 26%

If your health insurance premium increased for 2026, you are not alone. The ACA Marketplace is experiencing one of its largest pricing shifts in years, and many households are reviewing their coverage with a closer eye on monthly premiums, deductibles, provider networks, and tax-credit eligibility.

National estimates place the increase in ACA benchmark Silver premiums between approximately 21.7% and 26%, depending on the source and calculation method. Some HealthCare.gov states experienced average increases closer to 30%, while state-based Marketplaces generally saw smaller average increases. Median proposed insurer rate increases were reported at roughly 18%, and unsubsidized enrollee premiums rose by approximately 19.7% in some analyses.

At the same time, enhanced premium tax credits expired at the end of 2025. The original ACA rule limiting premium tax credits to households at or below 400% of the federal poverty level is back in effect. This means some consumers are facing a double financial challenge: higher gross premiums and less financial assistance.

This guide explains how to choose health insurance in a higher-cost 2026 market. It covers plan types, metal tiers, networks, deductibles, subsidies, and practical questions to ask during your research.

Important: eMavio is not a licensed insurance agency, insurance agent, broker, carrier, or government entity. eMavio does not provide insurance advice, plan comparisons, coverage recommendations, enrollment assistance, or plan selection. eMavio is a lead-generation platform that helps consumers research their options and connect with local, state-licensed insurance professionals. Using eMavio is 100% free for consumers.

Why health insurance costs are rising in 2026

Several market changes are contributing to higher Marketplace costs.

According to the Urban Institute’s 2026 ACA premium analysis, the national, population-weighted benchmark Silver premium increased approximately 21.7% from 2025 to 2026. Other analyses, including KFF’s 2026 Marketplace premium review, place the national average increase closer to 26%.

These figures are not necessarily contradictory. They may use different:

• Rating areas

• Age assumptions

• State groupings

• Premium definitions

• Benchmark or average plan measurements

• Enrollment weights

The practical lesson is that national percentages are useful for understanding the overall market, but they do not predict the premium for a specific person or family. Your price depends on factors such as location, age, household size, income, tobacco use, plan availability, and tax-credit eligibility.

The subsidy change adds another layer

Enhanced ACA premium tax credits helped lower premiums for many households and removed the previous 400% FPL subsidy cliff. Those enhanced credits expired after 2025.

For 2026, the original subsidy structure is back. Households above 400% of the federal poverty level may no longer qualify for a premium tax credit, while eligible households below that level may receive a smaller credit than they received under the enhanced rules.

This is one reason an enrollee’s actual monthly payment may increase much more than the underlying plan premium. KFF reported average monthly enrollee payments rising from approximately $113 in 2025 to $178 in 2026. Unsubsidized consumers generally feel the full effect of the gross premium increase.

Enrollment and deductibles are also changing

Early 2026 estimates indicate that Marketplace enrollment is down by several million people compared with 2025. Some summaries describe the decline as roughly 3 million, while early KFF analyses estimated a larger decrease in effectuated enrollment. These numbers vary depending on whether the comparison uses paid enrollment, projected enrollment, or a policy baseline.

Deductibles have also risen sharply. KFF reported that the average Marketplace deductible increased from approximately $2,759 in 2025 to $3,786 in 2026: an increase of about $1,027, or 37%.

Many families are responding to higher premiums by considering plans with lower monthly costs and higher deductibles. That can reduce the immediate budget pressure while increasing the amount a household may pay when it uses medical services.

Step 1: Identify the coverage path you are researching

Before reviewing plan details, identify which type of coverage applies to your situation. The rules, enrollment periods, and financial assistance can differ substantially.

ACA Marketplace plans

ACA Marketplace plans are individual and family policies that comply with the Affordable Care Act. They are generally available to people who do not have access to affordable employer-sponsored coverage or another qualifying form of insurance.

ACA-compliant Marketplace plans generally include:

• Coverage for essential health benefits

• Protection for people with pre-existing conditions

• Preventive services covered according to federal requirements

• Metal-tier classifications

• Annual limits on in-network covered cost-sharing

• Potential eligibility for premium tax credits

The official Marketplace for your state is the place to verify current eligibility, plan availability, premiums, and benefits.

Medicaid and CHIP

Depending on household income, family size, state, age, disability status, or pregnancy, someone in your household may qualify for Medicaid or the Children’s Health Insurance Program.

When completing an official Marketplace application, the information you provide may help determine whether you qualify for Medicaid or CHIP rather than Marketplace financial assistance. Eligibility rules are state-specific, so do not rely on a national estimate alone.

Employer-sponsored coverage

If you have access to an employer plan, review its employee contribution, deductible, provider network, and eligibility rules before assuming a Marketplace plan is your only option.

A job change, reduction in work hours, loss of employer coverage, or change in household status may create a Special Enrollment Period. Keep written notices about coverage loss because they may be relevant when applying.

COBRA and temporary coverage

COBRA may allow eligible workers and dependents to continue an employer plan after certain qualifying events. However, the individual may be responsible for the full premium plus an administrative charge.

Short-term health insurance may also be available in some states, but it is not the same as comprehensive ACA Marketplace coverage. Short-term policies can have different rules involving pre-existing conditions, essential benefits, renewals, exclusions, and maximum coverage periods. Read the policy documents carefully.

Step 2: Understand the ACA metal tiers

ACA Marketplace plans are grouped into metal tiers. The tiers describe the expected division of covered medical costs between the plan and the enrollee. They do not indicate that one tier provides better-quality doctors or better medical care.

The official HealthCare.gov explanation of plan categories provides a general overview.

Bronze

Bronze plans generally have lower monthly premiums and higher deductibles and other out-of-pocket costs. They may appeal to consumers who are primarily focused on reducing their monthly bill, but the deductible and out-of-pocket maximum still need careful review.

A lower premium does not mean that medical care will be inexpensive when you use the plan.

Silver

Silver plans generally fall between Bronze and Gold in premium and cost-sharing levels. Silver is also the tier associated with cost-sharing reductions for eligible consumers.

Cost-sharing reductions can lower deductibles, copayments, coinsurance, and out-of-pocket maximums. Unlike premium tax credits, cost-sharing reductions are tied to eligibility and enrollment in a Silver plan.

Gold

Gold plans generally have higher monthly premiums and lower cost-sharing than Bronze or standard Silver plans. The specific deductible, copayments, coinsurance, and network rules vary by policy.

Do not evaluate a Gold plan by its metal label alone. Read the Summary of Benefits and Coverage for the actual numbers.

Platinum

Platinum plans generally have the highest monthly premiums and lower cost-sharing. Platinum availability is limited in some locations, and the details vary by issuer and rating area.

Catastrophic plans

Catastrophic plans generally have very high deductibles and are designed primarily for protection against serious medical expenses. Eligibility is limited by age and certain hardship or affordability rules.

Preventive services may be covered before the deductible under federal requirements, but other care can involve substantial out-of-pocket expenses until the deductible is met.

Step 3: Evaluate the network structure

A plan’s provider network can affect both access and total cost. A premium that appears affordable may not work well for a household if its preferred doctors, hospitals, specialists, or pharmacies are outside the network.

Common network structures include the following.

HMO networks

Health Maintenance Organization plans generally use a defined network and may require members to select a primary care provider. Referrals may be required for some specialist care, and nonemergency out-of-network care may not be covered.

PPO networks

Preferred Provider Organization plans generally offer more flexibility for seeing specialists and may include some out-of-network benefits. However, out-of-network deductibles, coinsurance, and balance-billing exposure can be higher.

EPO networks

Exclusive Provider Organization plans typically cover care only from in-network providers, except for emergencies. They may not require referrals, but network verification remains important.

POS networks

Point-of-Service plans combine features of HMO and PPO structures. The plan may offer different cost levels for in-network and out-of-network care and may include referral requirements.

Network names are not enough. Check the specific provider directory for the exact plan and year. A doctor may participate with one plan from an insurer but not another.