With ACA premiums expected to rise in 2026, Fortune 500 employees should compare marketplace and employer-related options early, model net costs with and without current subsidies, and coordinate with HR and a qualified tax professional for decisions suited to their situation." — Patrick Ray, a representative of The Retirement Group, a division of Wealth Enhancement Group.

With ACA marketplace premiums expected to climb in 2026, Fortune 500 employees should compare employer and marketplace options early, estimate net costs under both current and lapsed subsidy scenarios, and coordinate with HR and a qualified tax professional to align coverage with their budget." — Michael Corgiat, a representative of The Retirement Group, a division of Wealth Enhancement Group.

• In this article we will discuss:

  1. The expected premium increases for ACA marketplace plans in 2026 and their potential impact on Fortune 500 employees and retirees.

  2. The major national insurers and states with the largest requested rate hikes.

  3. The primary economic, legislative, and industry factors driving these increases.

  In 2026, health insurance rates for plans purchased through the Affordable Care Act (ACA) marketplace are expected to surge, with several states requesting increases exceeding 60%. For Fortune 500 employees and retirees using ACA coverage, this could mean a substantial rise in healthcare costs. State insurance filings and industry publications point to higher medical expenses, the potential end of enhanced federal premium subsidies, and significant rate-hike proposals from major insurers as key drivers of the increase.

  According to KFF’s analyses, the vast majority of marketplace enrollees receive premium tax credits, and if the enhanced credits expire after 2025, average out-of-pocket premium payments for subsidized enrollees could rise by more than 75% in 2026.  As of January 2025, 24.2 million people selected 2025 marketplace coverage, and about 93% of marketplace enrollees rely on premium tax credits. KFF also reports that requested premium increases for 2026 are the largest in years, with most proposals falling between roughly 12% and 27% and a median near the mid-teens across reviewed filings.

  Top 10 States With the Largest Requested Premium Increases for 2026:

  • New York: UnitedHealthcare requesting up to +66.4% (individual market).

  • Arkansas: QualChoice +54.4%, Ambetter (Celtic) +42.5%, statewide average +36.1%.

  • Colorado: Western Slope ~+38.8%; statewide average +28.4%. Rocky Mountain HMO +36.4%, Cigna +29.4%, Anthem +33.6%, Kaiser +15.3%.

  • Florida: Molina ~+41%, Florida Blue +27%, Centene Venture +18.73%

  • Maine: Anthem (revised) +24.8%; statewide weighted average +25.9%.

  • Washington: 14 insurers; requested average +21.2%.

  • Vermont: BCBS Vermont +23.3%. 

  • Maryland: Requested statewide average +17.1% (individual market).

  • Illinois: BCBS Illinois +27%. 

  • Texas: BCBS Texas +21%.

  Major National Insurers and Their 2026 Requests:

  • UnitedHealthcare (UnitedHealth Group): Up to +66.4% in New York.

  • Elevance Health (Anthem BCBS): +33.6% in Colorado; +24.8% in Maine. 

  • Kaiser Permanente: +15.3% in Colorado (individual market). 

  • Centene Corporation (Ambetter/Celtic): +42.5% in Arkansas; +18.73% in Florida.

  • Cigna Healthcare: +29.4% in Colorado. 

  • Molina Healthcare: ~41% in Florida.

  • HCSC (BCBS IL, TX): +27% in Illinois; +21% in Texas. 

  • GuideWell (Florida Blue): +27% in Florida. 

  • CareFirst BlueCross BlueShield: Maryland requested statewide average +17.1%.

  • CVS Health/Aetna: Withdrawing ACA marketplace plans in 17 states in 2026, affecting ~1 million members.

  Key Factors Driving the Increases:

  • Loss of Enhanced Premium Subsidies: The American Rescue Plan and Inflation Reduction Act extended ACA subsidies through 2025. Without renewal, subsidized enrollees could see sharp increases in monthly premiums beginning in 2026 (KFF estimates more than a 75% jump in average out-of-pocket premiums for subsidized enrollees if the enhancements lapse).

  • Medical Cost Inflation: Leading consultancies report elevated medical cost trend heading into 2026—about 7.5% in the individual market and 8.5% in the group market—driven by hospital/physician services and prescription drugs.

  • Regulatory Shifts: Market rules and state laws have influenced filings. For example, analysts note federal policy changes (e.g., the Marketplace Integrity rule) as a factor cited in filings, and Arkansas enacted a first-in-the-nation law restricting PBM ownership of pharmacies (currently under legal challenge), adding operational uncertainty for vertically integrated insurers/PBMs.

Sources:

1. Ortaliza, Jared, et al. “How Much and Why ACA Marketplace Premiums Are Going Up in 2026.” KFF, 6 Aug. 2025, https://www.kff.org/affordable-care-act/issue-brief/how-much-and-why-aca-marketplace-premiums-are-going-up-in-2026/.

2. New York State Department of Financial Services. “Summary of 2026 Requested Rate Actions.” DFS Portal, 2 June 2025, https://myportal.dfs.ny.gov/web/prior-approval/ind-and-sg-medical/summary-of-2026-requested-rate-actions.

3. PwC Health Research Institute. Medical Cost Trend: Behind the Numbers 2026. PwC, 16 July 2025, https://www.pwc.com/us/en/industries/health-industries/library/behind-the-numbers.html.

4. Centers for Medicare & Medicaid Services (CMS). Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability (Final Rule). 18 June 2025, PDF, https://www.cms.gov/files/document/cms-9884-f-2025-pi-rule-master-5cr-062025.pdf.

5. Minemyer, Paige. “Aetna to Exit the ACA Exchanges in 2026.” Fierce Healthcare, 1 May 2025, https://www.fiercehealthcare.com/payers/aetna-exit-aca-exchanges-2026.
Pages/Sections referenced: Article body noting ~1 million exchange members and the 2026 exit (single web page; n. pag.).