Why Marketplace Health Insurance Has Become So Expensive in 2026—and What You Can Do About It

If you’ve seen the recent Wall Street Journal story about the Florida couple who lost their Marketplace health insurance because they could no longer afford the premiums, you’re not alone.

Many people have assumed the Affordable Care Act (ACA) ended or that Marketplace coverage disappeared.

Neither is true.

What actually changed is the expiration of the temporary enhanced premium tax credits that were created during the COVID-19 pandemic. Those enhanced subsidies allowed many middle-income Americans who previously earned too much to qualify for financial assistance.

Now that those temporary tax credits have expired, many families are once again paying the full cost of health insurance.

But that’s only part of the story.

Why Are Marketplace Health Insurance Premiums Increasing?

Several factors are driving higher Marketplace health insurance premiums in 2026 and beyond.

1. Enhanced Premium Tax Credits Expired

The enhanced ACA subsidies significantly reduced premiums for millions of Americans.

When those subsidies expired, many healthy individuals found Marketplace coverage too expensive and chose to go uninsured or seek alternatives.

2. The Marketplace Risk Pool Changed

Health insurance works by spreading medical costs across a large group of people.

When healthier individuals leave the Marketplace, the remaining insured population often has higher healthcare costs. Insurance companies must account for that increased risk when calculating future premiums.

This doesn’t happen overnight, but actuarial projections reflect who insurers expect will remain enrolled.

3. Healthcare Costs Continue to Rise

Marketplace premiums aren’t increasing because of one single issue.

Insurance companies must also account for:

• Higher hospital reimbursement rates
• Increasing physician costs
• Rising prescription drug expenses
• Medical inflation
• Greater healthcare utilization since COVID-19
• Ongoing shortages of healthcare professionals

Combined, these factors create significant upward pressure on premiums.

Who Is Being Hit the Hardest?

The people I worry about most are individuals between ages 55 and 64.

Many are:

• Self-employed
• Retiring before Medicare
• Working part-time
• Living on investments
• No longer receiving employer-sponsored health insurance

They’re too young for Medicare but often face some of the highest individual health insurance premiums available.

A Real Client Example

Recently, I spent nearly four hours helping a couple in their early 60s navigate their health insurance options.

That is extremely unusual.

Most clients complete our entire process—including strategy, plan selection, enrollment, and education—in about an hour or less.

This case was different because of both Marketplace processing issues and the complexity of today’s health insurance landscape.

Their estimated household income was approximately $110,000.

If both spouses enrolled in the lowest-cost Bronze PPO available through the Marketplace, their monthly premium would have exceeded $4,000 per month.

That’s more than $48,000 every year before receiving medical care.

Because the plan also carried a high deductible of nearly $7,000, their total annual healthcare exposure could have exceeded $60,000 if they experienced a significant medical event.

Simply put—that wasn’t sustainable.

The Strategy That Saved Thousands

After reviewing every available option, we developed a different strategy.

One spouse enrolled in a Marketplace HMO for approximately $1,200 per month.

The other qualified for a medically underwritten individual plan outside the Marketplace for approximately $600 per month.

Their combined premium dropped to about $1,800 per month.

That’s still expensive.

But it’s less than half the cost of the Marketplace PPO option they originally considered.

Every family’s situation is different, and medically underwritten plans are not available or appropriate for everyone. However, understanding every available option is essential before making a decision.

Why Planning Before Open Enrollment Matters

One of the biggest mistakes I see is waiting until Open Enrollment begins before exploring options.

By then, there is often very little time to discuss larger financial strategies.

For many households—especially those who are self-employed or retired before Medicare—income planning may affect eligibility for premium tax credits.

Those conversations often need to happen months before Open Enrollment.

In many cases, collaborating with a qualified tax professional or financial advisor can help determine whether adjustments to taxable income are possible and appropriate.

An Insurance Agent Should Do More Than Click “Enroll”

Many people believe an insurance agent simply submits an application.

That’s only a small part of the job.

An experienced independent health insurance agent should help clients:

• Compare Marketplace and private health insurance options
• Understand premium tax credit eligibility
• Evaluate provider networks
• Compare deductibles and out-of-pocket costs
• Explain trade-offs between plan types
• Review prescription drug coverage
• Coordinate health insurance with retirement planning
• Develop long-term strategies instead of making last-minute decisions

Sometimes there isn’t a cheaper option.

But there is almost always value in understanding every available choice.

Should You Review Your Health Insurance Before Open Enrollment?

If any of these describe you, the answer is yes.

• You’re self-employed.
• You’re retiring before age 65.
• You’re between ages 55 and 64.
• Your Marketplace premiums have become unaffordable.
• Your income is close to the subsidy eligibility threshold.
• You’re automatically renewing your current plan without reviewing alternatives.

Many people assume they simply have to accept whatever renewal arrives in the mail.

That isn’t always true.

Sometimes there aren’t better options.

Sometimes there are.

The key is finding out before Open Enrollment becomes overwhelming.

Frequently Asked Questions

Did the Affordable Care Act end?

No. The Affordable Care Act is still in effect. What changed was the expiration of the temporary enhanced premium tax credits that expanded subsidy eligibility for many middle-income households.

Why did Marketplace premiums increase so much?

Premiums are influenced by multiple factors, including the expiration of enhanced subsidies, changes in the Marketplace risk pool, medical inflation, higher provider reimbursement, rising prescription drug costs, and increased healthcare utilization.

Can I qualify for Marketplace subsidies if my income is too high?

Possibly. Eligibility depends on your projected household Modified Adjusted Gross Income (MAGI), family size, and the current federal rules. Income planning should be discussed before Open Enrollment whenever possible.

Are plans outside the Marketplace available?

Yes. Depending on your state, health history, and eligibility, medically underwritten individual plans or other coverage options may be available. These plans are not appropriate for everyone and generally require answering health questions.

Should I wait until Open Enrollment to review my options?

No. The best time to develop a strategy is before Open Enrollment begins. Waiting until renewal season often limits the time available to explore income strategies, compare plans, and coordinate with tax or retirement planning.

Final Thoughts

Health insurance has become increasingly complicated.

The right solution isn’t always finding the cheapest premium—it’s finding the best balance between premiums, deductibles, provider access, prescription coverage, and your long-term financial goals.

If you’re self-employed, planning to retire before Medicare, or simply overwhelmed by rising health insurance costs, now is the time to start planning—not after Open Enrollment begins.

At Mere Benefits, we help individuals, families, and retirees understand their options and build a strategy that fits their unique situation.

If you’d like to review your health insurance options or prepare for the 2027 Marketplace, contact Mere Benefits at 904-654-5450 or reach out to schedule a consultation.