ACA Marketplace and Health Insurance Premium Changes 2026
- Dec 16, 2025
- 4 min read
Hi everyone,
Now that open enrollment has started for most everyone, I wanted to give a rundown of what to expect on the Florida ACA Marketplace this next year and some stats to keep everyone in the loop and prepared for what is to come. Note: this at present (11/12/25) is based on the enhanced ACA subsidies expiring with NO recourse set forth by this current Congress. Should this change I will update this post.
TL;DR: Health insurance is getting (in many cases, way) more expensive. There will be less practical options for people and many more will go without insurance next year. Be prepared for your practices and your patients.
Changes to the ACA Marketplace
For the year 2026, the following changes will happen with the actual ACA Marketplace in Florida:
Aetna is leaving the ACA Marketplace across the country. So patients will no longer have the option to select an Aetna ACA plan. This is a blow to accessibility for Registered Interns who are being supervisory billed by their supervisors.
Amerihealth/Caritas has also left the Marketplace, but that happened this year, not starting next year.
Simply is rebranding to Wellpoint, still using the Carelon network (so you need to have a contract with Carelon commercial contracts).
The current list of ACA Marketplace plan providers in 2026 is as follows:
Florida Blue/BCBS
United Healthcare/Av-Med/Oscar
Cigna
Molina
Capital Health
Ambetter/Centene
Health First
22 Health
Molina
Wellpointe (re: Simply)
Premium and Plan Benefit Changes
As of right now, the enhanced ACA tax subsidies enacted during the first Trump term for COVID relief are expired. That means that:
There is now a hard drop off of receiving any subsidies if a household makes 400% above the Federal Poverty Limit (in 2025 in FL, ~$62,000 for an individual person, scaling up about $15000 per each additional person in a family). These decreases in assistance also scale up much faster. KFF calculated that next year, a person making $28,000 a year on an ACA plan this year would pay roughly $325 annually for their health insurance premium, compared to next year paying $1562. That’s just in premiums.
In general, across all payment ranges, premium payments total are expected to double next year, with increases varying heavily depending on where someone falls in the range of income.
ACA premium increases also depend on age: the older you are, the higher your insurance will go. KFF states the following: “Enrollees with incomes above 400% of poverty will be subject to large increases in premium payments if enhanced premium tax credits expire. On average, a 60-year-old couple making $85,000 (or 402% FPL) would see yearly premium payments rise by over $22,600 in 2026, after accounting for an annual premium increase of 18%. This would bring the cost of a benchmark plan to about a quarter of this couple’s annual income, up from 8.5%. Meanwhile, a 45-year-old earning $20,000 (or 128% FPL) in a non-Medicaid expansion state would see their premium payments for a benchmark plan rise from $0 to $420 per year, on average, from the loss of enhanced premium tax credits. About half (45%) of ACA Marketplace enrollees have incomes between 100-150% of poverty, about a fourth (28%) have incomes between 150-250% of poverty, and roughly 1 in 10 have incomes above 400% of poverty.”
On average, premiums across the board are increasing 18%. Depending on what kind of subsidy you may receive, this number may balloon all the way up to 300-400%.
While many ACA plans are deciding to focus on premium increases, some have also adjusted plan terms: higher deductibles, OOP Maxes, and lowered insurer contributions for services.
Other Insurance Changes
Even those with employer plans are seeing increases and plan adjustments: we are all part of the same general risk pools, so when the ACA Marketplace struggles, employer plans change in open enrollment.
Employer pricing is not publicly available so it is difficult to say changes or adjustments at this point. But expect many employers to post increases to premiums or changes to benefits. Some companies my decide to absorb changes in costs for their employees, with possible ramifications later on down the line.
Practical Steps for Your Practice
These changes can have effects on your practice and the care your patients receive, so it is imperative that you stay on top of things. Here are some recommendations I suggest:
Go over open enrollment with each of your patients. Put this time on their radar and have them review their expected healthcare needs over the next year and what might change.
Review your own insurance contracts and self-pay policies- there may be patients who decide to forgo health insurance and may want to speak with you about private pay sliding scale. Be ready to go with GFEs and how you would like to address it with them.
Your schedule may change at times due to patients deciding to scale back services because of costs: prepare for this. This is a good time to review your own financial situation and the solvency of your practice to see how much you can reliably “brunt” while this is all going on. You never know.
Check your own health insurance premiums and costs. Remember, depending on how you get your health insurance, you may be able to write off some premium costs on your taxes. Maximize the financial strain over time for your own self.
And as always, if there is anything we can do to help, feel free to post in the comments and let us know. 🙂
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