The 2026 ACA marketplace is experiencing its most significant disruption since enhanced premium subsidies were enacted in 2021, contributing to material changes in size and composition. With enhanced subsidies expiring, benchmark silver premiums rising by an average of 30%, and consumer purchasing patterns expected to shift dramatically, health insurers in 2026 face both unprecedented challenges and strategic opportunities.
Net premiums after subsidies in 2026 are projected to increase by an average of 65% for bronze plans, 121% for silver plans, and 80% for gold plans, though the impact varies materially by state, county, income level, and age. The changes will reshape enrollment patterns, risk pools, and competitive positioning across the individual market. This white paper discusses what health insurers need to know—and the actions they should take now—to better position themselves for 2026 and beyond.
Highlights
- Organizational implications: Effects on strategy, financial metrics, marketing and sales, and operations
- Benchmark silver premium: Increases outpacing those of bronze and gold, perhaps a silver lining
- Zerodollar premium: Not gone, but harder to find
- Segmentation: Average numbers obscure enormous variation
- Catastrophic plans: Expanded eligibility may fundamentally change the risk profile of the catastrophic pool.
- Recommended actions: Immediate, near-term, and 2027 planning