ACA Premiums May Rise—Here’s Why, and What to Do About It

If you get health insurance through the Affordable Care Act marketplace, here’s something worth knowing now, before your 2026 renewal notice ruins a perfectly good fall day. There’s a decent chance your premiums may go up, possibly by a lot. This isn’t a scare tactic. It’s just the math starting to shift, and it helps to understand why.

What’s Going On?

During the pandemic, Congress supercharged ACA subsidies, making coverage more affordable for more people. Families earning well into six figures suddenly qualified for help, and out-of-pocket costs dropped for millions. The result? ACA enrollment more than doubled, and average premiums fell by over $700 a year. That temporary boost is still in place, but it expires at the end of 2025, unless Congress acts.

Here’s the kicker: If those subsidies go away, insurers know two things will happen:

1. Fewer people will buy coverage.
2. The ones who stay will be sicker and older.

That’s the insurance version of a bad party: no young people, no music, and everyone’s talking about their cholesterol numbers. So to prepare, many insurers are asking regulators for the biggest premium hikes in over five years. They’re pricing in the risk of losing their healthiest customers.

This is why we may see the dreaded combo punch in 2026:

• Higher sticker prices from insurers
• Lower subsidies (or none at all) from the government

Can Congress Stop This?

Yes. But they must choose to.

Right now, those enhanced subsidies are set to sunset after 2025. That wasn’t a clerical error; that was a compromise baked into the legislation. If Congress wants to keep them going, they’ll need to pass a new law to extend or make them permanent.

That means getting a majority in the House and Senate to agree on the same thing, at the same time, during an election year… so, yeah. It’s possible. But it’s not exactly what Vegas would call a lock.

And here’s the non-partisan reality: healthcare is expensive, and no one wants to own the headline “We made it worse.” So, there’s a chance something gets done.

A Real-Life Example

Let’s say you’re a married couple earning $100,000 a year and currently enrolled in a mid-level ACA plan through Blue Cross Blue Shield of North Carolina. Today, with enhanced subsidies in place, you might pay around $700/month for that coverage. But with those subsidies set to expire and BCBS requesting a 29% premium increase, your monthly cost could rise to $1,200 or more, depending on your ages and the plan you choose. That’s a potential $6,000+ swing per year—for the same insurer, the same coverage tier, just with different math behind it.

To be clear: that 29% increase is a proposed rate, not yet approved, but it’s a good indicator of how insurers are preparing for the road ahead. You can view those filings directly on the NC Department of Insurance website here:

Initial ACA Rates for Plan Year 2026 (NCDOI)

So What Can You Do?

You don’t need to panic. But you do need a plan.

Here’s where I’d start:

1. Preview your 2026 costs.
   If your state exchange allows it, log in and check projected premiums. Even rough estimates can help you plan ahead.
2. Start building a cushion.
   If your budget allows, set aside an extra $100–$200/month now. It adds up fast and gives you breathing room later.
3. Revisit job-based insurance options.
   If either spouse is self-employed or working part-time, now may be the time to consider roles with employer-sponsored coverage.
4. Handle any care you’ve been putting off.
   Think screenings, procedures, or dental work. Do it in 2025 while coverage is more predictable and subsidies are still in effect.
5. Consider accelerating income into 2025.
   Since premium subsidies are tied to your adjusted gross income, you might consider realizing income this year while the enhanced subsidies are still in place. That could mean:
   • Taking capital gains early
   • Doing Roth conversions
   • Pulling forward IRA distributions if you’re eligible
   • Deferring deductions until 2026

The idea is to take income on your terms, not the government’s, especially if you’re expecting reduced benefits going forward.