Regular readers know that I've been obsessing over the massive increases in both gross as well as net premiums for ACA health insurance policy enrollees for well over a year now (over a decade now, really, but it's been especially high on my mind the past year or so).
I've written countless analyses of how much both of these metrics skyrocketed from 2025 to 2026 across different states, different income levels and various other demographics.
As I've repeatedly warned, however, the increases in premium costs (whether gross or net) are only half the story. The other big shoe which is dropping this year is increased out of pocket costs as millions of the ~19.2 million or so Americans who were still enrolled in effectuated ACA exchange coverage as of April have been forced to downgrade their coverage to avoid (or at least minimize) those massive premium spikes.
Annual Family Premiums for Employer Coverage Rise 6% in 2025, Nearing $27,000, with Workers Paying $6,850 Toward Premiums Out of Their Paychecks
More of the Largest Firms Cover GLP-1s for Weight Loss, and Use Is Higher Than Expected; Some May Be Limiting Coverage
Family premiums for employer-sponsored health insurance reached an average of $26,993 this year,KFF’s annual benchmark health benefits survey of large and smaller employers finds. On average, workers contribute $6,850 annually to the cost of family coverage, with employers paying the rest.
DENVER – Last Thursday, Connect for Health Colorado’s Board of Directors took a support position on House Bill 24-1258 Credit Covered Person Expenses Insurer Insolvency. This bill will require a covered individual’s new health insurance company to credit out-of-pocket expenses paid if their current health insurance company leaves the market mid-plan year and can no longer provide coverage. This bill also provides methods for health insurance companies to recoup any expenses and increase in claims liability because of crediting out-of-pocket expenses. Connect for Health Colorado has released the following statement:
This is a HUGE deal, especially in California, where an estimated 430,000 residents are enrolled in off-exchange ACA policies which are virtually identical to their on-exchange equivalent, with the sole distinction of those enrolled in them not being eligible for ACA subsidies.
With subsidies being beefed up and the 400% FPL subsidy cliff having been killed (for the next 2 years, at least), this means that hundreds of thousands of Californians have just become eligible for thousands of dollars in savings...as long as they transition to the same plan on-exchange.
In the United States, major medical insurance policies for those who don't have healthcare coverage through their employer, Medicare, Medicaid, CHIP, the Veteran's Administration or some other source are available via the ACA's individual market exchanges. The individual market for residents of 36 states is HealthCare.Gov; the remaining 14 states + DC each have their own ACA exchange, such as Covered California, NY State of Health and so forth.
There are usually dozens of ACA policies available via the ACA exchanges, but they fall into five major categories: Catastrophic, Bronze, Silver, Gold and Platinum plans (other major distinctions include HMOs vs. PPOs and other variables,but those are for another day).
With rare exceptions, Catastrophic plans are only available to enrollees under 30 years old. ACA premium subsidies can't be used to help pay for Catastrophic plans either, so enrollment is rare; during the 2020 Open Enrollment Period, only 89,000 ACA exchange enrollees selected Catastrophic plans out of over 11.4 million total, or just 0.8%.
