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Health Insurance Costs Spike as Major Policy Changes Hit in 2026
Millions of Americans face a projected 114% increase in health insurance premiums as enhanced Affordable Care Act subsidies expire.
Key Points
- Millions of Americans face a projected 114% increase in health insurance premiums as enhanced Affordable Care Act subsidies expire.
- Medicare implements its first-ever negotiated drug prices but also raises the standard Part B premium to nearly $203.
- A new federal rule requires insurers to respond to urgent prior authorization requests within 72 hours for certain government-funded plans.
- States like California and Connecticut are enacting their own health insurance laws, including insulin copay caps and mandatory biomarker test coverage.
The era of pandemic-era health insurance affordability is officially over. As of January 1, enhanced Affordable Care Act subsidies have expired, triggering massive premium hikes and projected coverage losses for millions of Americans who buy their own insurance.
The price is wrong: The sticker shock is real: A KFF analysis projects the average premium for subsidized enrollees will skyrocket by a staggering 114%. The political gridlock that led to a 43-day government shutdown failed to produce a deal to extend the credits. The Urban Institute projects the change will cause nearly 5 million people to drop their health coverage altogether in 2026.
Medicare's new math: It’s not just the ACA market in turmoil. Medicare is undergoing its own seismic shifts. Under the Inflation Reduction Act, the first-ever negotiated prices for 10 high-cost drugs take effect now. While CMS projects this will save beneficiaries $1.5 billion annually, other expenses are rising; the agency announced the standard Part B premium climbs to nearly $203, and the annual Part D spending cap rises to $2,100.
The waiting game ends: Meanwhile, the federal government is cracking down on prior authorization. Under a new CMS rule, the clock is now ticking faster: Medicare Advantage, Medicaid, and CHIP plans must approve or deny urgent requests within 72 hours and standard ones within a week. Insurers must also now provide specific reasons for any denials.
States go it alone: As federal policies create chaos, states are forging their own paths. California now requires a $35 insulin copay cap and has banned pharmacy benefit managers from using "spread pricing" models. Connecticut now requires coverage for biomarker testing, and Delaware is mandating coverage for abortion services.
For millions, 2026 marks a jarring return to pre-pandemic healthcare economics, where affordability is once again a major hurdle, even as new rules attempt to chip away at administrative and prescription cost burdens.
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