It’s no secret that health care in the U.S. is expensive. In fact, Americans often spend two to three times more than those in other wealthy nations for similar or better outcomes. Some form of health insurance coverage – whether employer-sponsored plans, Medicare, Medicaid, or buying direct through the ACA Marketplace – may not eliminate out-of-pocket costs for health care but it does go a long way for many families. But even that represents a potentially significant expenditure for American families.

For instance, the out-of-pocket premiums for a family of four covered under an employer sponsored health insurance averages from $6,500 to $7,500 per year.

Those buying insurance directly through the ACA Marketplace, however, will spend two to three times more: between $18,000 to $24,000 per year without subsidies. Regardless of where consumers buy their insurance, almost all are finding their premiums rising an average of 4 to 6 percent annually. This year, though, costs are expected to jump even higher by roughly twice the rate of inflation, or as much as 7 percent.

But 2026 could see an even bigger jump in health insurance premiums. Last year saw the passage of legislation that stripped pandemic-era ACA subsidies from roughly 20 million Americans. The huge jump in cost for these individuals has forced many to go without. Since the beginning of the year total ACA participants has declined by 5 percent, and that number will likely grow throughout 2026.

That reduction in the insurance coverage pool is impacting insurers. Because sicker individuals with greater needs keep their coverage while healthy individuals are more likely to out, insurers are retrenching from markets where it’s no longer economically feasible.

Citing financial sustainability, several insurers are leaving either or both the Medicare Advantage and ACA marketplaces. For instance, Aetna/CVS Health is leaving individual marketing places in 17 states. UnitedHealthcare and Humana have reduced their service areas in a large number of rural communities where, the insurers report, medical costs are higher than in more densely populated communities.