Open enrollment for the Affordable Care Act’s (ACA’s) marketplaces is just one week away, and premiums are set for a massive spike, federal documents show.
Reporters at The Washington Post reviewed data from the Centers for Medicare & Medicaid Services (CMS), and final rate approvals show an average premium increase of 30% for next year. This figure is far and away the highest increase in the past several years.
“Window shopping” for plans available on HealthCare.gov opens Monday, with the enrollment period beginning Nov. 1. That means enrollees will see early next week the full extent of cost increases they may face, per the Post article.
The ACA market is at the center of the ongoing government shutdown, with Democrats pressing for an extension to enhanced premium tax credits available for these plans. The subsidies were first implemented in response to the COVID-19 pandemic and have driven record highs in enrollment on the exchanges.
Republicans have pushed instead to end the shutdown with a “clean” continuing resolution and then circle back to the subsidies and other policy priorities.
Between the expiring subsides and rising utilization and acuity in this market, insurers proposed significant premium increases for the 2026 plan year. Analysts at KFF found a median premium request of 18% next year, 11 percentage points higher than the median for 2025.
CMS Administrator Mehmet Oz, M.D., told “Meet the Press” this week that the ACA “has been sick” since its inception and that it only worsened during the pandemic, including with the rollout of the subsidies. He instead that the system requires a complete restructuring.
“To do that you need smart people like the kinds of folks we have in this beautiful building I’m speaking to you from, which houses [the Department of Health and Human Services] and the agency I run, Medicare and Medicaid—but they’re not here now, they’re furloughed, they’re at home,” he said.
The CMS since revealed that its employees would be recalled Monday ahead of open enrollment beginning and with two weeks of Medicare’s annual enrollment period having been open for seniors.
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