US health insurance is expensive because medical care costs a lot. In 2026, smaller subsidies also left people paying more. The US spent $5.3 trillion on health care in 2024, or $15,474 per person. Insurers set premiums to cover these costs.
Four main factors explain the price:
- Medical costs keep rising. Hospital spending rose 8.9% in 2024, and doctor and clinical services spending rose 8.1%.
- Premiums rise too. Benchmark marketplace premiums rose 26% on average in 2026, and insurers requested a median 15% increase for 2027.
- Out-of-pocket costs are rising. The average marketplace deductible reached a record $3,786 in 2026.
- Subsidies fell. The enhanced Affordable Care Act (ACA) tax credits expired at the end of 2025, and the average monthly premium payment after credits rose 58%.
Individual Health Insurance Enrollment Fell 18% in One Year
Data released on October 14, 2026, shows that enrollment in the individual health insurance market fell 18% in one year. Enrollment dropped from 25.2 million people in June 2025 to 20.5 million in June 2026, a loss of more than 4.6 million.
The individual market is where people buy insurance themselves instead of getting it through a job or government program. Most use ACA marketplaces, often called Obamacare, including HealthCare.gov. The decline followed the end of enhanced ACA subsidies and other policy changes. In one survey, 17% of returning enrollees were unsure they could afford their 2026 premiums all year.
When healthier people leave, those who stay tend to cost insurers more. Insurers added about four percentage points to their requested 2027 increases because they expect more people to leave and the remaining group to be sicker.
This does not mean all 4.6 million people became uninsured. Some moved to other types of coverage, and the enrollment data does not show where everyone went.
What Goes Into the Price You Pay for Health Insurance?
Premiums Keep Climbing
A premium is your monthly insurance bill. The 26% increase applies to the benchmark plan, the area's second-lowest-cost silver plan, which helps set federal subsidy amounts. If insurers get their requested 2027 increases, typical premiums will have risen by more than one-third in two years.
Job-based insurance is getting pricier too. In 2025, the average yearly family premium reached $26,993, up 6% in a year while wages rose 4%. Workers paid an average of $6,850.
Deductibles, Copayments, and Out-of-Pocket Costs
Your premium is not the only cost. Most plans also have a deductible (what you pay before the plan starts paying), a copayment (a fixed fee, such as $30 per visit), or coinsurance (a share of the bill, such as 20%).
These costs are rising too. The average marketplace deductible rose 37% in 2026, mainly because more people chose cheaper plans with higher deductibles. For workers with job-based coverage, the average deductible for one person is $1,886, and about one in three has a deductible of $2,000 or more.
Federal rules limit how much you can pay in a year for covered care from in-network providers: $10,600 for one person in 2026 and $12,000 in 2027. Your monthly premium does not count toward this limit.
Medical Costs Drive What Insurers Charge
Insurers set premiums by estimating next year's medical claims. Federal law requires them to spend at least 80% or 85% of premium dollars on medical care, depending on the market, and give rebates if they fall short. When care gets more expensive, premiums usually rise too.
In 2027 filings from 16 states and DC, insurers expect medical care and prescription drug costs to rise by a median 10%, compared with about 8% a year recently. They cite higher prices, inflation, staff shortages, costlier claims per visit, and expensive drugs such as GLP-1 weight-loss medicines.
How Subsidies Change What You Pay
The full plan price is not always what you pay. Most marketplace shoppers get a premium tax credit that covers part of the monthly bill. The credit is based on the benchmark plan's price minus the share of income you are expected to pay. A higher benchmark price can mean a bigger credit; higher income usually means a smaller one. In 2026, 87% of sign-ups received a credit.
Not everyone qualifies. In 2025, a 40-year-old in Indianapolis earning $65,000 paid $316 a month for a silver plan with a full price of $388. This income is just above the 400% credit cutoff, so the credit ended in 2026 and the bill rose to the full price of $477. Insurers have requested $546 for 2027.
Why Costs Differ by State, Age, Income, and Plan
- State: Prices can vary by location, using rating areas set by each state. In 2026, benchmark premiums rose 69% in Arkansas and 41% in Washington, but only 3% in New York and 2% in Vermont. Some states provide extra help. New Mexico is temporarily replacing all the lost federal assistance.
- Age: An older adult can be charged up to three times as much as a younger adult for the same plan. Tobacco users can be charged up to 1.5 times as much.
- Income: Credits generally get smaller as income rises and stop for people above 400% of the federal poverty level.
- Plan: Plans with lower monthly premiums usually leave you paying more when you get care. A bronze plan pays about 60% of costs, while a gold plan pays about 80% and usually has a lower deductible.
What Changed With Obamacare Subsidies?
The term “Obamacare subsidies” can refer to two types of help, but only one ended. The enhanced premium tax credits expired on December 31, 2025. Standard ACA premium tax credits are still available to eligible households.
The Enhanced Credits Expired
Congress created the enhanced credits in 2021 and extended them through 2025. When they expired, the original rules returned:
| Rule | Enhanced credits | Standard credits |
|---|---|---|
| Years | 2021 to 2025 | Current law for 2026 and 2027 |
| Income limit | None | 400% of the federal poverty level |
| Share of income paid for a benchmark plan | Up to 8.5% | 2.10% to 9.96% in 2026; 2.15% to 10.22% in 2027 |
| Lowest incomes | $0 for a low-deductible silver plan, up to 150% of poverty | 4.19% of income at 150% of poverty, about $82 a month for one person |
With less help, people pay more. The average monthly premium payment after credits rose from $113 to $178 in 2026. The share of people signing up who received credits fell from 92% to 87%.
Congress has not restored the enhanced credits. On January 8, 2026, the House passed a three-year extension by a vote of 230 to 196. The Senate has not passed it, and the bill has been on its calendar since February 10.
The Separate October 14 Announcement
In 2026, CMS found 189,000 people who had subsidized federal marketplace coverage but also had duplicate Medicare, Medicaid, or CHIP coverage, or were listed as deceased. CMS removed their subsidies. The move could save taxpayers about $1.5 billion over the next year.
This is separate from the end of the enhanced credits and affects only accounts CMS flagged. CMS contacts those people and gives them 30 days to dispute the finding. If they do not respond, CMS ends their marketplace subsidy, though they can still appeal. They keep any Medicaid or Medicare coverage. Only the duplicate marketplace subsidy ends.
This follows the rules: people who qualify for government programs such as Medicaid, Medicare, or CHIP generally cannot also receive premium tax credits.
Why Are Fewer Americans Enrolling in Health Insurance?
Higher costs are a major reason fewer people enroll, but reduced subsidies, missed payments, other coverage, and enforcement also play a part.
Cost Is a Big Part of the Story
People earning between 400% and 500% of the poverty level made up only 3% of marketplace sign-ups in 2025, but 27% of the drop in 2026. Adults ages 18 to 34 accounted for 46% of the decline. This fits insurers' expectation that younger, usually healthier people would be more likely to leave.
Signing Up Is Not the Same as Staying Covered
Sign-ups, or plan selections, count people who choose a plan or are automatically re-enrolled. “Effectuated enrollment” counts those who paid their premiums and kept coverage active.
In 2026, 23.1 million people signed up or were automatically re-enrolled, about 1.2 million fewer than a year earlier. In February, enrollment among people who had paid fell 12%, from 21.8 million to 19.2 million. Returning subsidized enrollees get a three-month grace period for missed payments, so some losses appear after it ends.
Not Everyone Who Left Is Uninsured
In a survey of 2025 marketplace enrollees, 22% had moved to other coverage and 9% were uninsured. Other options include a job-based plan, Medicaid, Medicare, or a parent's plan until age 26.
Cost is not the only reason people lose insurance. Among adults uninsured for less than three years, the top reasons in 2024 were losing a job or changing employers (39.7%), losing Medicaid or other public coverage (25.6%), and higher costs (19.2%).
Enforcement also matters. In 2025, CMS ended subsidies or coverage for nearly 1.5 million people who did not qualify for financial help or had enrolled without permission. In September, CMS moved to cancel about 315,000 unauthorized enrollments covering more than 760,000 people.
Going Without Coverage Carries Real Risks
In 2024, 38.6% of uninsured adults delayed or skipped care or medicine because of cost, versus 17.0% of privately insured adults. About 34% of uninsured adults under 65 had overdue medical bills, compared with 26% of insured adults.
After open enrollment ends, you can sign up for marketplace coverage only if you qualify for a Special Enrollment Period.
What Can Americans Do if Health Insurance Is Becoming Unaffordable?
Open enrollment for 2027 marketplace coverage starts November 1, 2026. Sign up or change plans by December 15 for January 1 coverage. Enrollment ends January 15; sign-ups from December 16 to January 15 start February 1. State-run marketplaces may have different dates.
1. Compare total costs, not just premiums. Your yearly cost includes premiums, deductibles, copayments, and coinsurance, up to the out-of-pocket maximum. These can add up to more than premiums alone. HealthCare.gov's plan comparison tool estimates total costs based on low, medium, or high expected care needs.
2. Check for credits and extra savings. When you apply, you'll learn whether you qualify for a premium tax credit or extra savings on deductibles and copayments, available only with silver plans. Use expected 2027 income, since credits are based on your estimate for the coverage year. You may have to repay advance credits you did not qualify for. The tool uses 2026 figures to check extra savings until November 1. Many miss out: only 45% of eligible people in HealthCare.gov states chose a plan with extra savings in 2026, down from 66%.
3. Compare job-based coverage. Compare any employer plan with marketplace plans. Employers usually pay part of the premium, and you lose that help if you switch. You generally cannot get marketplace savings if your job offers affordable coverage that meets minimum standards. For 2027, affordable means your premium share is no more than 10.22% of household income. If it costs more, you or family members may qualify for savings, and applying carries no risk.
4. Check Medicaid and CHIP. You can apply any time, even if you think your income is too high. Rules vary by state. Ten states have not expanded Medicaid. In the 40 states and DC that have, adults earning up to 138% of the poverty level may qualify. New work requirements for expansion adults start in January 2027.
5. Check doctors, hospitals, prescriptions, and deductibles. HealthCare.gov's plan comparison tool shows whether plans cover your doctors, hospitals, and prescriptions in network. HMOs and PPOs differ in choice and out-of-network costs. Consider whether you could afford the deductible in a year when you need a lot of care.
Rules and prices depend on your state and household. Check HealthCare.gov or your state's marketplace for details, or use its Find Local Help tool.
What Happens Next to US Health Insurance Costs?
- 2027 premiums: Across 276 insurers in all 50 states and DC, the median requested increase is 15%. Requests are preliminary and may change. Last year, the median request was 18% and the final median increase was 20%. Check HealthCare.gov or your state marketplace for your actual price.
- Subsidy rules: Watch for Senate action on the House-approved extension of enhanced credits. On October 14, Treasury and the IRS proposed new credit rules, including eligibility and verification requirements for 2027. The proposals may change before becoming final.
- Enrollment figures: The 20.5 million figure is a June snapshot, and enrollment may keep falling. Watch for federal data on 2027 sign-ups.
- Insurer and employer responses: Some insurers have dropped coverage for GLP-1 weight-loss drugs as costs rise. New data on 2026 employer coverage costs is due October 22.
We'll update this section as new official figures are released.
FAQ
Why did my health insurance premium go up so much?
Two things happened at once. Benchmark marketplace premiums rose in 2026, and the enhanced tax credits expired, so many people received less help.
How much does health insurance cost per month?
It depends on how you get coverage. In 2025, job-based insurance averaged about $780 a month for one person and $2,250 for a family. Workers paid about $120 and $570 of those amounts, respectively. On the marketplace, the average monthly payment after credits was $178 in 2026.
Why is health care so much more expensive in the US than in other countries?
In 2021, the US spent nearly twice as much per person as comparable wealthy countries. Most of the gap comes from higher hospital and doctor payments, plus administrative costs. There is little evidence that Americans use more care: they have shorter hospital stays and fewer doctor visits per person, but pay higher prices.
Did the ACA subsidies end, and will they come back?
The enhanced tax credits expired on December 31, 2025, but standard ACA credits are still available. The House passed a three-year extension in January 2026, but the Senate has not passed it.
Who qualifies for ACA premium tax credits, and what is the 400% cutoff?
You may qualify if your income is within the allowed range, your job does not offer affordable coverage that meets minimum standards, and you are not eligible for Medicaid, Medicare, or CHIP. The cutoff is 400% of the federal poverty level. Above it, you get no credit, so even a small raise can cost you the full credit. Proposed 2027 rules would also limit credits to US citizens, US nationals, and certain lawfully present noncitizens.
Will health insurance premiums rise in 2027?
Insurers have requested a median increase of 15%, but the requests are not final. People who receive premium tax credits may be partly protected because the credit is linked to the benchmark plan's price. People who do not qualify for credits pay the full increase.
When does open enrollment start, and can I sign up later?
Open enrollment for 2027 coverage runs November 1, 2026, to January 15, 2027. Sign up by December 15 for January 1 coverage. Later, you can enroll only if you qualify for a Special Enrollment Period, such as after moving, losing coverage, getting married, or having a baby. Medicaid and CHIP accept applications year-round.
What is the difference between a premium and a deductible?
A premium is the monthly bill, whether or not you use care. A deductible is what you pay for covered services each year before the plan starts paying, except for free preventive care. After that, you pay copayments or coinsurance until you reach your out-of-pocket maximum.
How many people lost health insurance in 2026?
Individual-market enrollment fell by more than 4.6 million people, or 18%, between June 2025 and June 2026. This does not mean all of them became uninsured, because many moved to other coverage.
Is a bronze, silver, or gold plan better?
It depends on how much care you expect to need. Bronze plans usually cost less each month but more when you get care. Gold plans usually cost more each month but less when you get care. Silver plans are the only ones that offer extra savings on deductibles and copayments for people who qualify. The plan names do not indicate quality of care.
The Bottom Line
US health insurance costs more because medical care is expensive, and smaller subsidies shifted more of the bill to consumers in 2026. Individual-market enrollment fell 18% in a year, but not everyone who left became uninsured. If your costs rose, compare yearly costs, check for credits or Medicaid, and enroll by December 15 for January 1 coverage. Start at HealthCare.gov.
Sources
- Centers for Medicare & Medicaid Services (CMS): https://www.cms.gov/
- KFF: https://www.kff.org/
- HealthCare.gov: https://www.healthcare.gov/
- Internal Revenue Service (IRS): https://www.irs.gov/
- U.S. House of Representatives: https://www.house.gov/
- Federal Register: https://www.federalregister.gov/