9 Big Changes in Health Insurance for 2026

Health insurance

4

minute read

Aug 26, 2025

9 Big Changes in Health Insurance for 2026

Next year will be a challenging one for health insurance across the board, let's break down the biggest changes coming in 2026.

Marshall Darr
Co-founder & CEO

Key takeaways

Rising Costs Across the Board: ACA marketplace premiums, deductibles, and out-of-pocket maximums are all expected to increase significantly in 2026, putting more financial pressure on individuals and small businesses.

Shifts in Coverage Options: Enhanced ACA subsidies are set to expire, Aetna is exiting the ACA marketplace, and off-exchange plans are gaining traction as a more flexible and potentially cost-effective alternative.

ICHRA Adoption on the Rise: Small businesses are increasingly turning to ICHRA as a cost-effective and flexible solution for offering health benefits, with adoption rates expected to grow even further in 2026.

1. ACA marketplace premiums likely to increase 10–27% in 2026

While nothing is finalized until states publish rates in October, early projections show ACA marketplace premiums could rise between 10% and 27% next year. Some regions will see sharper increases while others will stay closer to the low end.

What this likely means: there’s going to be more pressure than ever in 2026 for small businesses to offer a health benefit given how expensive the alternative is going to be for their employees.

2. Deductibles and out-of-pocket maximums will be higher

For 2026, the maximum out-of-pocket (OOP) costs for ACA-compliant (non-grandfathered) plans will rise significantly. These limits are set by the government each year.

That’s roughly a 15.2% increase year over year.

What this likely means: Squeezed on both ends. This is tough news when paired with the rise in overall premiums. The most likely outcome is that people will be migrating to cheaper plans in order to balance their budgets, while seeing the cheaper plans become more expensive before they start really offering coverage.

3. Enhanced ACA subsidies are set to expire, raising net premium costs

The premium tax credit enhancements first introduced under the American Rescue Plan Act and later extended via the Inflation Reduction Act are scheduled to end December 31, 2025, unless Congress acts to renew them.

Without renewal:

What this likely means: price increases combined with diminished federal relief is again making it look like employers will be left to bridge the gap. We’ll likely see a corresponding increase in both employer spending and the uninsured rate as a result of both.

4. Off-Exchange plans may see smaller rate hikes and increased access

Finally - some good news. Carriers are actively investing in direct-to-consumer policies commonly referred to as “off-exchange” policies. These tend to have less structural requirements than policies listed on the ACA which allows for more wiggle room when it comes to plan design and pricing.

What this likely means: we’re expecting a large growth in off-ex enrollments this year for the market as a whole.

5. Aetna exiting ACA marketplace effective Jan. 1, 2026

One of the largest ACA carrier exits in years is happening: Aetna is pulling out of the ACA marketplace nationwide. While Aetna has only about 8% of the U.S. individual market overall, it’s a major player in some regions.

What this likely means: Aetna is a large health insurance provider on the individual market in major states like Florida and all of those people will need to find a new home for their health insurance.

6. Illinois launching state-based ACA exchange

After years of discussion, Illinois will officially launch its own state-based exchange for the 2026 plan year.

What this likely means: states that launch their own state-based exchanges tend to experience a little bit of rockiness in year one when it comes to enrollments.

7. Open Enrollment to be shorter in 2026

The ACA’s Open Enrollment Period runs November 1 through December 15 but pretty much every year it’s been extended through January 15. In 2026, the extension likely will not happen — meaning December 15, 2025, could be the hard deadline for 2026 coverage.

What this likely means: Don’t procrastinate! If you get your coverage through the ACA health insurance marketplace or are currently covered through an ICHRA, if you miss the December 15th deadline, there’s a chance you won’t have access to health insurance until the next open enrollment period a year from now.

8. Small Group Plans are still expected to rise in double-digits, too

Group health insurance isn’t looking much brighter than the individual market. The same pressures are pushing fully insured small group premiums higher (and have been for years).

What this likely means: Small businesses will keep struggling to find health coverage that actually fits their needs without blowing up the budget. ICHRA will continue to rise and become a more viable option especially for employers with under 20 employees.

9. ICHRA adoption will continue to increase - setting it on pace to be the primary vehicle SMBs offer their health benefits through by 2030.

We’ve come a long way since 2023 when we started StretchDollar and no one knew what an ICHRA was. Employers are tired of cost unpredictability, compliance complexity, and being the middle man between employees and their healthcare decisions - that’s fueling more interest than ever before in ICHRA.

ICHRA adoption grew by 52% with small, non-ALE employers last year and we’re expecting market pressures to push that adoption rate even higher in 2026.