Health premiums in the Affordable Care Act Marketplace will rise by double- or triple-digit percentages, according to some forecasts, while experts say the numbers can be misleading.

To get the full picture, it’s necessary to understand what’s happening with the federal subsidies that help pay for the insurance known as Obamacare and how the rising costs are being presented.

Most Marketplace users will still find affordable coverage, experts say. But that doesn’t mean health care costs are not skyrocketing beneath the surface.

Here’s how the Marketplace works and what to expect when selecting a plan for 2026.

How It Works

People with household income between 100 percent and 400 percent of the federal poverty level receive a subsidy from the federal government to help buy health coverage through the Marketplace.

The federal poverty level is based on household size and is adjusted annually.

People who earn less than 100 percent of the federal poverty level qualify for Medicaid, which has no premium. People earning less than 138 percent may qualify in the 40 states with expanded Medicaid.

The Marketplace subsidy is paid directly to the insurer, so enrollees who qualify pay only the reduced premium.

Five levels of plans are available: bronze, silver, gold, platinum, and catastrophic. The bronze plans have the lowest premium but typically have higher out-of-pocket expenses, and the platinum plans have the best coverage and the highest premium.

Rates Rising

Marketplace premium rates are rising for 2026 for two reasons, according to Ethan Pickner, founder of AZ Health Insurance Brokers.

The first concerns the temporary, expanded health care subsidies instituted during the COVID-19 pandemic.

“With the enhanced premium tax credits going away, the insurers are anticipating more healthy enrollees getting off of marketplace plans,” Pickner told The Epoch Times. “The remaining people on the plans tend to be less healthy and more expensive to insure.”

Those enhanced premium tax credits expanded Marketplace access to people making more than 400 percent of the federal poverty level. They also capped premium payments for Marketplace customers at 8.5 percent of their household income. Congress determined that those temporary subsidies would expire at the end of 2025.

In 2025, about 22.4 million people, or about 92 percent of all enrollees, benefited from the enhanced subsidies, according to the Bipartisan Policy Center, a Washington-based think tank.

The second reason rates are rising is the increase in costs.

“The cost of care is more expensive across the board,” Pickner said, citing the rising use of injectable weight loss drugs and other brand-name medications.

Pickner said rates have risen by 29 percent to 35 percent in Maricopa County, Arizona, for 2026, depending on the chosen plan and insurer.

Rates will rise by an average of 26 percent for platinum plans in 2026, and some customers could see increases of 114 percent, according to health policy center KFF.

Rates May Mislead

Those numbers don’t tell the whole story, according to some experts, partly because they don’t include the value of the subsidies that many who are enrolled will get.

“Subsidies will still be available for people earning up to 400 percent of the federal poverty level—about $62,000 for a single person or $128,000 for a family of four,” Whitney Stidom, vice president of consumer enablement at eHealth Inc., told The Epoch Times.

“Millions of enrollees will still find that federal subsidies cover most, or a very significant portion, of their total monthly premium.”

Stidom cited an example of a person enrolled in an Affordable Care Act plan with a total premium of $500 per month. An enrollee may have paid $100 out of pocket toward the premium, with the rest covered by federal subsidies.

In this example, a 75 percent hike in cost might be more affordable than it first appears, Stidom said.

“After the end of enhanced subsidies, they may be required to pay $175 toward that $500 total instead,” she said.

However, premiums will remain low for most customers and decrease for some, according to the Centers for Medicare and Medicaid Services.

Premium tax credits are expected to cover 91 percent of the cost for the lowest-priced plan in 2026, usually called the bronze plan. That’s more than the 85 percent covered in 2020, before the enhanced premiums were temporarily authorized.

In 2026, the average enrollee will pay $50 per month for health coverage after the premium tax credit is applied. That’s an increase of about $13 over 2025, but it’s lower than the 2020 amount.

About 60 percent of enrollees will be able to buy their chosen plan for $50 per month after the subsidies are applied, according to the government’s estimate.

Subsidy Expiration Effects Vary

The effects of the expiring enhanced subsidies vary greatly among Marketplace enrollees.

For example, a family of four with a household income of about $64,000 would have received an additional $245 per month in 2026 if the enhanced subsidies were still in place.

Yet a family of four earning $161,000 would have received enhanced subsidies of more than $785 per month.

In all, about 10 percent of marketplace enrollees will receive no subsidy when the enhanced subsidies expire. These customers are in households making more than 400 percent of the federal poverty level.

Without the enhanced subsidies, the remaining 90 percent of enrollees would see an out-of-pocket increase of 1 to 2 percent of their household income.

For a family of four making 100 percent of the federal poverty level, the maximum out-of-pocket increase for coverage would be $54 per month. For a family making 400 percent of the federal poverty level, the maximum increase would be $107 per month.

Cost Rising For Everyone

The hidden problem, according to one expert, is that federal health insurance subsidies hide the explosive increase in cost from millions of Americans.

“The real, unsubsidized costs are still climbing fast, in some cases well into the double-digit percentages,” Neal K. Shah, chairman at CounterForce Health, told The Epoch Times.

Shah, a researcher funded by the National Institutes of Health, said the United States has developed a “two-track insurance economy.”

“Folks on [Marketplace] subsidies feel somewhat insulated, while middle-class families and small businesses are getting crushed by premiums that keep outpacing their wages,” Shah said.

“The Affordable Care Act didn’t really fix the broken cost structure of insurance; it just shifted who pays for it.”

To cope with rising costs, insurers are not just increasing premiums but also tightening claim approvals and shrinking networks.

About 8.8 million of some 46 million in-network claims were denied in 2024 across HealthCare.gov states, according to Money Geek.

“Americans are paying more every year for ‘health insurance’ and getting less care in return,” Shah said.

To make the most of the Marketplace, Stidom recommends getting advice on choosing a plan. “Comparing plans can potentially save people an average of over $2,000 per year—all while keeping comparable benefit levels,” she said.

Pickner helped one family cope with a rate increase from $49 per month after subsidies to $299 per month.

“Their carrier had a significant rate increase, so we can switch to a more cost-effective carrier for $120 a month or stay with the same carrier and go with a bronze plan to keep the price similar for 2026,” Pickner said.

Marketplace enrollment is open through Dec. 15 for coverage beginning Jan. 1. The final deadline for enrollment is Jan. 15 in most states.