We’re dusting off the old crystal ball and making some predictions as to what you can expect when it comes to individual market health insurance policies next year. This year’s has a lot more in flux than most so the lines here blur between predictions and confirmed updates but it’s the guidance we’re operating off of internally at StretchDollar (and we thought we’d share it with you).
That said, it’s looking like there’s more bad news than good news for this turn. Broadly speaking, this is a readjustment. Shifts in the market and in the political realities it’s based upon are going to have very real effects on our pocket books this year.
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.
One thing to note: Fully insured small group health plans are also expected to go up, though likely by a smaller percentage than ACA marketplace rates. Unfortunately - it’s looking like most all healthcare options will be more expensive in 2026 than they were in 2025.
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.
- Self-only coverage: $10,600 (up from $9,200 in 2025)
- Family coverage: $21,200 (up from $18,400 in 2025)
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.
Quick reminder: Your out-of-pocket maximum is the most you'll ever have to pay for covered medical expenses in a year. Once you hit this limit, your insurance will take care of any extra eligible medical costs.
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:
- Net premiums for persons who are taking the subsidy (meaning the amount enrollees actually pay after subsidies) could rise by over 75% on average starting in 2026.
- Gross premiums (total cost of health insurance without a subsidy applied) could rise an additional 1–7 percentage points in some states due to shifts in the risk pool.
These enhanced subsidies were a major factor in record-high ACA enrollment — projections show that without them, marketplace enrollment could drop from 22.8 million in 2025 to 18.9 million in 2026.
When will we know? Probably at the last minute. It’s unclear which direction Congress is headed. Our take: total expiration and total extension are unlikely. More likely is an extension of a smaller-sized tax credit.
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.
Quick reminder: The risk pool is the group of people whose health costs get averaged together. If the risk pool includes more sick people, then costs can drive up for everyone. If the risk pool includes more healthy people, then costs can go lower. To get a deep dive on subsidies, read ACA Subsidies Explained.
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.
Some carriers are signaling that off-exchange ACA-compliant plans will have smaller rate increases than on-exchange plans. Access is also improving — more insurers are working hard to make their plans more accessible, allowing brokers and consumers to quote and enroll in multiple off-exchange plans from one platform.
What this likely means: we’re expecting a large growth in off-ex enrollments this year for the market as a whole. At StretchDollar we’re actually going to be surfacing these options even before ACA plans for employees this year and we expect other administrators to do the same.
Quick reminder: ACA-compliant plans are health insurance plans that play by the federal government rules outlined in the Affordable Care Act. That means they cover the basics (like doctor visits, prescriptions, maternity, mental health), can’t deny you for pre-existing conditions, and cap your out-of-pocket costs. (Rules that make sense!)
On-exchange plans are ones that you see on Healthcare.gov and that allow premium tax credit/subsidies. Off-exchange plans are offered by health insurance carriers that comply with federal rules but do not allow premium tax credits.
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. And this isn’t their first exit – in 2018 Aetna left, only to return in 2021.
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. While other carriers will likely make county-level coverage map changes, it will be hard to fill the gap left by Aetna.
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. No other states have confirmed a similar move for 2026, but this is one to watch in future years.
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. If you’re in Illinois and get your plans through healthcare.gov be sure to get started on your 1/1 enrollments earlier this year.
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.
Quick reminder: ICHRA or individual coverage health reimbursement arrangement is a type of health benefit that lets employers give pre-tax money to employees for health insurance plans they choose. StretchDollar offers an ICHRA. You can read more here: A Not-So-Boring, One-Page Guide to ICHRA
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). These include rising health care costs, lagging inflation, and pricey medicines. Adding to that pressure is that the small group market is still shrinking.
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. (See ICHRA vs Small Group Health Insurance.
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.
