In 2026, typical health insurance premium costs will explode. The average premium for benchmark Affordable Care Act plans is projected to jump up 26%. Insurers are subject to growing criticism on Capitol Hill. This understandably sends workers, Medicare beneficiaries, and people enrolled in the Affordable Care Act into crisis. Continuing to allow unregulated costs to skyrocket, many Americans are losing the financial battle of them getting the care they need.
This staggering premium increase comes on the heels of the nationwide rise in healthcare costs, making healthcare more unaffordable by the day. Insurers are under significant pressure as lawmakers continue to look into why costs have skyrocketed. In addition to 2024’s historic increase, workers are facing larger than normal hikes in their health insurance premiums this year. Medicare Part B premiums have increased almost 10%. Beneficiaries currently pay $202.90 per month, that’s a $17.90 increase from last year.
The Impact on Workers and Employers
Employers are getting ready for an even bigger test to come. They project health benefit costs to increase by 9%, the biggest jump in at least 5 years. Many companies are already starting to see some pretty disconcerting trends among their employees. For one, employees below the suggested screening ages are developing cancers much earlier than expected. These issues combine to create increasing costs for employers, who need to both offer competitive, high-quality coverage and control costs that are rapidly increasing.
At the same time, enrollees in health insurance plans are experiencing much sharper real out of pocket premium expenses. The expiration of these enhanced federal subsidies will lead to an average premium increase of 114%. This shift increases the economic cost of care on the people and families that use these plans to meet their healthcare needs.
“There’s not as much incentive to drive the hardest bargain if you’re not on the hook for most of the increased prices yourself.” – Vivian Ho
Hospital Consolidation and Rising Costs
A lesser known but equally important reason for rising premiums is hospital consolidation. In 2023, one or two health systems controlled 50% or more of inpatient care in almost a third of these metropolitan areas. This consolidation has increased prices and decreased quality of services, as competition vanishes. It is made even worse by the widespread and growing practice of hospitals acquiring physician practices, raising costs for patients.
Industry experts have stressed that hospital care continues to be a key driver of where costs are accelerating unchecked. According to PhRMA, “The data clearly show that the largest part of the health care system — hospital care — is the place where costs are the most out of control.” We’re seeing hospitals merge together and expand their reach. If finalized, many patients will face higher out-of-pocket expenses for necessary medical treatment.
Shifting Trends in Coverage and Care
Recognizing that backdrop, it’s hard not to be struck by some emerging trends in health insurance coverage. By 2025, large firms—with the three very large firms that cover GLP-1s for obesity—raising their share to 43%. This was a major increase from only 28% the year before. This reflects a growing recognition of obesity’s impact on overall health and the importance of addressing it through medical intervention.
Utilization of behavioral health services is surging among policyholders. In brief, during the second quarter of 2025, only 10.1% of policyholders visited an office for behavioral health. This is a huge jump from the 7.1% of auto trips during the same time in 2019. This trend is an encouraging sign of a greater awareness and acceptance of mental health issues among the American public.
The healthcare environment is changing rapidly with the impact of greater hospital employment of physicians. In 2024, 55% of physicians were employed by hospitals. This stat is indicative not only of the new dynamics within the medical profession, but what that means for patients.
As these trends continue to develop, stakeholders from all corners of the healthcare system are focused on them. Meanwhile, insurers are still under intense scrutiny in Washington and patients continue to deal with increasing costs. The future of health insurance affordability lies in addressing these systemic obstacles. We will need to identify opportunities that provide coverage expansion benefits with less overall cost.