Open Enrollment Shock: 2026 Rates & Out-of-Pocket Costs Jump as Subsidy Enhancements Roll Back
Oct 30 • Written by Robert Adams
Open Enrollment Shock: 2026 Rates & Out-of-Pocket Costs Jump as Subsidy Enhancements Roll Back
Fast take: 2026 Marketplace premiums are up, maximum out-of-pocket limits increased, and enhanced subsidies are rolling back. A typical family of four (two 36-year-old adults + two kids) saw the lowest Bronze option jump from $1,267/mo in 2025 (OOP max $9,200) to $1,667/mo in 2026 (OOP max $10,000).
Open Enrollment is here. If you simply “let it renew,” you’ll likely pay more in 2026—often for less protection. Rate filings show across-the-board increases driven by medical inflation and policy changes. With the enhanced subsidies rolling back, many middle-income families now feel the full price pressure.
What changed for 2026
- Premiums: Double-digit increases are common across Bronze/Silver/Gold.
- Max out-of-pocket: Raised again for 2026 (example above: $9,200 → $10,000).
- Subsidy rollbacks: The expanded tax credits that softened 2024–2025 pricing are fading, raising net costs for many households.
Real-world snapshot (family of 4)
- 2025 lowest Bronze: $1,267/mo • Deductible $6,500 • OOP max $9,200.
- 2026 lowest Bronze: $1,667/mo • Deductible $7,500 • OOP max $10,000.
Same family, same metal tier—meaningfully higher monthly cost and higher exposure before the plan pays fully.
Don’t renew blind. We compare ACA vs. Private PPO side-by-side and confirm your doctors.
Moves to make now
- Price the real year: Premium + expected usage (copays/coinsurance) + deductible + OOP risk.
- Check doctors & meds: Verify network and formulary before you enroll.
- Compare ACA vs. Private PPO: If you qualify medically, PPOs can cut total cost and OOP exposure.
We’ll verify your doctors/prescriptions, model 2026 costs, and enroll you correctly—no pressure, just answers.
Quick FAQs
Will 2026 increases hit me immediately?
Yes—your 2026 premium and OOP limits apply based on your effective date. We’ll confirm your exact numbers.
Are Private PPOs available in my state?
Often, yes (underwriting required). We’ll pre-screen and confirm networks.
Can you confirm my doctors are in-network?
Yes. That’s step one before we quote anything.
For education only; eligibility, benefits, and availability vary by carrier and state. Always review official plan documents.
Robert Adams
RKA Insurance Advisors • Private & Marketplace Health Coverage
561-806-9913 •
info@RKAinsuranceadvisors.com •
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