Healthcare costs are rising—and fast. Brokers and industry experts are sounding the alarm: health insurance premiums, both for individuals and employer-sponsored plans, are expected to increase significantly in 2026. This one’s relevant whether you’re shopping for coverage for yourself, your family, or your employees.

Here’s what’s fueling the increase—and how you can stay ahead.

Why Premiums Are Heading Up

Sicker risk pools in the ACA marketplace: healthier members are dropping coverage, shifting costs toward those who need care most.

Expensive medications are a key driver. Costly GLP-1 drugs used for managing diabetes and obesity (i.e., Ozempic, Wegovy) are pushing up pharmacy expenditures. Added to that are high-cost treatments like gene therapies and innovative cancer drugs.

More claims overall, especially for mental health and emergency care, are straining insurer budgets.

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What It Means for Individuals

Expect plans to change. Higher deductibles, narrower networks, and tougher prescription rules (e.g. caps or separate drug deductibles) could become the norm.

If you get your coverage via the ACA marketplace, be ready for premium increases of up to 20% and potentially even higher out-of-pocket costs—unless federal subsidies are renewed beyond 2025.

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What It Means for Employers & Business Owners

Employer-sponsored coverage isn’t immune. Many companies are already expecting costs to climb—and may have to shift more burden to employees through increased deductibles or benefits redesign.

If you help employees pay for individual plans (as some small business owners do), your budget may be strained even more. For example, one small business owner reimburses $350 per month per employee—and still can’t keep up with rising costs.

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What You Can Do Now

As an individual, shop your plans during open enrollment. If your state has a marketplace, look for options that balance cost and coverage. Prioritize value! Weigh out-of-pocket costs vs. premiums. Don’t just chase the cheapest plan; consider your overall financial exposure.

As an employer, talk to your broker about creative plan designs—like tiered networks, wellness incentives, or HSAs—to reduce risk and cost. Start having conversations now. Budgeting for 2026 increases and communicating transparently can prevent surprises later.

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Key Takeaway

2026 is shaping up to be a costly year for health insurance—across the board. If you’re insured individually or looking after your employees, now’s the time to strategize. Understanding upcoming hikes and preparing accordingly can help you make smarter decisions—and keep financial stress in check.

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📞 Need Assistance?
Whether you’re an individual or business owner navigating these rising costs, we’ve got your back. We can help you compare plans, redesign benefits, and structure cost-sharing in ways that protect people—and your bottom line. Contact our team today for personalized guidance and support tailored to your needs.

Sources

• IRS, Revenue Procedure 2025-19 — the official IRS announcement of 2026 inflation-adjusted limits for HSAs, HDHPs, and excepted-benefit HRAs. Read More
• McDermott Will & Emery, IRS Announces 2026 Limits for Health Savings Accounts, High-Deductible Health Plans, and Excepted-Benefit HRAs — detailed breakdown of changes. Read More
• Associated Press, Expect health insurance prices to rise next year, brokers and experts say — insights into projected premium hikes, underlying cost drivers, and ACA market pressures. Read More
• Health System Tracker (Kaiser Family Foundation), Individual market insurers requesting largest premium increases in more than 5 years — analysis of marketplace filings showing 15–20% requested increases. Read More
• Washington Post, The price increases that should cause Americans more alarm — data on surging ACA market premiums, with proposed increases ranging from 20% to over 66% in some states. Read More

This article is for informational purposes only and is not intended to provide legal, tax, or insurance advice. It should not be relied upon as a substitute for professional guidance regarding your specific circumstances. For advice tailored to your organization’s needs, please consult a licensed attorney, tax advisor, or benefits professional. © 2025 Apex Benefit Group. All rights reserved.