Retiring Early from Merck? Major Increases to 2026 ACA Premiums Projected in Several States

Healthcare Provider Update: Healthcare Provider for Merck Merck & Co., Inc., commonly known as Merck, is a global leader in the healthcare sector, renowned for its innovative pharmaceuticals, vaccines, and biologic therapies. As a prominent healthcare provider, Merck delivers a wide array of health solutions targeting various health conditions, particularly in areas such as immunology, oncology, and infectious diseases. Potential Healthcare Cost Increases in 2026 In 2026, healthcare costs are projected to rise significantly, primarily driven by the anticipated expiration of enhanced federal premium subsidies associated with the Affordable Care Act (ACA) and growing medical expenses. Faced with an average premium increase of 18%, healthcare consumers may experience out-of-pocket costs climbing by over 75%. This situation is exacerbated by surging medical care prices, as hospitals and providers seek to balance inflationary pressures while maintaining profitability. As a result, many individuals may find themselves priced out of adequate health coverage, prompting essential discussions on the need for policy interventions. Click here to learn more

'With 2026 ACA premiums set to rise, Merck employees approaching early retirement should integrate health care cost projections into their broader income planning to help maintain long-term financial stability.' – Brent Wolf, a representative of The Retirement Group, a division of Wealth Enhancement.

'Given the anticipated ACA premium hikes in 2026, Merck employees considering early retirement should evaluate how health care expenses fit within their retirement budget to support a sustainable financial plan.' – Paul Bergeron, a representative of The Retirement Group, a division of Wealth Enhancement.

In this article we will discuss:

1. The proposed2026 ACA premium increases and the states facing the steepest hikes.

2. Key economic and policy factors influencingthese premium changes.

3. Strategies retirees can use to help manage rising health care costs before Medicare eligibility.

Following recent changes to the Affordable Care Act (ACA), millions of Americans covered by ACA marketplace insurance may be set to see a sharp rise in their annual premiums. Preliminary estimates place the median national increase at 18%, ¹  with many states anticipated to exceed this level. Early filings cite the planned expiration of enhanced subsidies, ongoing medical inflation, the rising cost of specialty drugs, and broad policy and market pressures as contributors to premium jumps that could increase by as much as 30% in certain areas. ²

States With the Biggest Increases Under Consideration

While changes vary by insurer and plan, early filings identify five states with some of the steepest expected increases:

• Projected  →  Anticipated  increase of about 24%. UnitedHealthcare, for example, requested a 66.4% increase for specific ACA policies.

• Colorado: Insurers report statewide average increases in the high teens to 20% range, with some geographic areas facing hikes above 33%.

• Illinois: Blue Cross & Blue Shield of Illinois has filed for an almost 27% increase for 2026, placing the state among those with the highest expected rate changes.

• Rhode Island: Rate-review report shows a weighted average request in the low to high 20% range, depending on carrier.

• Washington: Fourteen individual-market insurers requested an average statewide increase of 21.2% for 2026.

Final approved rates will be determined later in the year following each state’s review process. However, the data so far indicates 2026 will be challenging for those on ACA coverage before Medicare eligibility. Nationwide, most planned increases fall between 12% and 27%, with many topping 20%.

Factors Contributing to the 2026 Increase

Several converging factors are influencing these rate hikes:

• 1. Expiration of Enhanced ACA Premium Subsidies: Without new legislation, temporary premium tax credits will end in 2026, raising monthly costs and potentially reducing enrollment among healthier individuals—worsening risk pools and pushing rates up.

• 2. Medical Inflation and Provider Pricing: Hospitals and health care providers are negotiating higher reimbursement rates to offset increased labor, supply, and inflationary costs.

• 3. High-Cost Pharmaceuticals: Specialty drugs, including GLP‑1 therapies for diabetes and weight management, are driving higher payouts, with expenses being pushed back to consumers.

• 4. Supply Chain Costs and Tariffs: Delays and tariffs on health care equipment and imports are contributing to insurers’ cost forecasts.

• 5. Risk Pool Deterioration: Rising rates may cause healthier enrollees to exit the market, raising the average cost for those remaining.

Ways to Manage Rising ACA Premium Costs

Financial planning professionals, including Brent Wolf and Paul Bergeron of Wealth Enhancement, note that proactive, tax-aware strategies can help Merck retirees mitigate these increases:

• Adjust Retirement Timing: Delaying retirement until closer to Medicare eligibility could reduce years of elevated ACA coverage costs.

• Manage Modified Adjusted Gross Income (MAGI): Strategic Roth conversions or income‑efficient withdrawals can help preserve eligibility for premium support.

• Contribute to a Health Savings Account (HSA): Full HSA funding offers pre‑tax contributions, tax‑deferred growth, and tax‑free withdrawals for qualified medical expenses.

• Compare Plans During Open Enrollment: Reviewing network access, cost-sharing, and prescription coverage across carriers can help identify more budget‑friendly options.

• Evaluate COBRA vs. ACA Coverage: Depending on age, health needs, and location, COBRA continuation may be cost effective for a limited time after leaving employer coverage.

• Use Special Enrollment Periods: Income or household changes may qualify enrollees for updated subsidies.

Particular Considerations in New York

New York’s ACA marketplace offers one of the most diverse plan selections nationwide, and rate requests vary widely. The Department of Financial Services releases carrier-level tables showing proposed changes. Significant hikes from carriers like United Healthcare and Oxford have attracted attention; ³  final approvals will be announced later this summer.

Looking Ahead

While rate increase reports remain preliminary, it appears that ACA enrollees may face substantial premium increases in 2026. For some households, rate hikes of 20–30% could mean hundreds more per month. For Fortune 500 employees considering retiring early, incorporating health care costs into broader tax and income planning will be vital.

According to Avalere Health and AARP’s Public Policy Institute, nearly five million adults aged 50–64 may experience average annual premium increases exceeding $4,000 if enhanced ACA subsidies lapse, and some could lose eligibility altogether. ⁴

With national rates expected to go up by a median of 18%—and more in specific states—retirees will need to adopt targeted planning. Thoughtful plan comparison, HSA contributions, and income management can offer some relief ahead of Medicare eligibility.

Retiring early before Medicare can be likened to setting sail toward an approaching storm. In 2026, the winds of expiring subsidies, medical inflation, and costly new treatments could make for turbulent conditions. By adjusting income strategies, funding HSAs, and choosing plans carefully, retirees may navigate these waters much like a seasoned captain charts a steady course through rough seas.

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Sources:

• 1. KFF. ' How Much and Why ACA Marketplace Premiums Are Going Up in 2026 ,' by J. Ortaliza, M. McGough, K. Vu, I. Telesford, S. Rakshit, E. Wager, L. Cotter, C. Cox. 6 Aug. 2025.

• 2. Fierce Healthcare. ' KFF analysis finds a median ACA premium hike of 18% for 2026 ,' by Paige Minemyer. 8 Aug. 2025.

• 3. ACASignups.net. ' 2026 Rate Changes - New York: +13.2% Avg ,' New York Department of Financial Services. 2 June 2025.

• 4. AARP. ' Expiring Tax Credit Threatens Affordable Health Coverage for Midlife Adults ,' by Jan Sung and Olivia Dean. 4 April 2025.