By skyforbes 
Originally Published in J. Powell’s LinknedIn Newsletter.
An analysis of premium increases and coverage changes across Medicare, Medicaid, and the ACA marketplace for 2026
The 24.2 million Americans enrolled in ACA marketplace plans face what could be the largest disruption to health insurance coverage since the Affordable Care Act’s implementation. As enhanced premium tax credits expire on December 31, 2025, the mathematics are brutal: without Congressional intervention, subsidized marketplace enrollees will see their premiums more than double on average, jumping 114% from $888 annually in 2025 to $1,904 in 2026. For some Americans, the increases will be even more dramatic — residents of Mississippi could face 314% increases, while those in Alaska might see their costs rise by 346%.
The Perfect Storm Brewing
The crisis extends far beyond simple sticker shock. Insurance companies across all 50 states have already submitted their 2026 rate proposals, requesting a median premium increase of 18% — the steepest climb since 2018. This isn’t just about the expiring subsidies. Healthcare costs continue their…