2025 vs. 2026 Marketplace Health Plans: Why Costs Are Jumping and What to Do Now
Open Enrollment • Nov 2 • Written by Robert Adams
2025 vs. 2026 Marketplace Health Plans: Why Costs Are Jumping and What to Do Now
Fast take:
2026 Marketplace plans are coming in higher than 2025 — and the max out-of-pocket limits are climbing too. At the same time, the federal fight over enhanced ACA subsidies means some families will see their net premiums rise even if their income stays the same. Best move: let us run Marketplace vs. Private PPO vs. COBRA escape for your exact household before you lock in the wrong plan.
- • Lower monthly premium than 2026 for same family profile
- • Max OOP was lower
- • Enhanced subsidies still helped a lot of ZIPs
- • Same kind of plan, higher premium
- • Higher max out-of-pocket — bad for families that actually use care
- • If enhanced subsidies roll back → net cost goes up again
Why are 2026 numbers worse?
What you noticed in Healthcare.gov was real — not a glitch. A few things are stacking at once:
- Medical trend & claims are higher → carriers file higher premiums.
- Max out-of-pocket is indexed → it creeps up every year, so 2026 is just… more.
- Subsidy uncertainty → if enhanced credits are rolled back, you feel the full hike instead of it being hidden by APTC.
- Family of 4 = multiplier → higher OOP hurts more when it’s 4 people hitting deductibles, RX, and visits.
What this means for a family of four (your example)
You were looking at a pretty normal setup — two 36-year-old adults, two kids. In 2025, you could still find a Marketplace EPO/Bronze that didn’t look insane. In 2026, that same lane is now showing:
- • Monthly premium noticeably higher
- • Deductible still high
- • Max OOP even higher → this is the real pain number
That’s exactly why we tell families: don’t shop Marketplace in a vacuum. Run it next to a private, medically underwritten PPO and, if you just lost a job, a COBRA-exit strategy.
Let’s lock the right 2026 plan for your ZIP.
We’ll run Marketplace vs. Private PPO vs. COBRA escape for your exact family of 4, verify doctors, and tell you which enrollment window you’re actually in.
What to do right now
1) Send household details
Ages, ZIP, income range → we can see if credits still help you.
2) Tell us your doctors
We’ll verify networks — 2026 plans don’t all keep the same providers.
3) Compare 3 paths
Marketplace (2025 vs 2026) • Private PPO (if eligible) • COBRA exit if you got laid off.
Quick FAQs
Will everyone see 2026 go up?
Not everyone — but families that don’t qualify for strong credits will feel it the most. That’s why we try to keep you in a credit-eligible lane or move you to a private PPO if that’s cleaner.
What if enhanced ACA subsidies get extended?
Great — we’ll re-run it. But you shouldn’t plan your whole year on Congress doing the right thing. Lock a plan that works even if credits shrink.
Can I switch mid-year if 2026 is too high?
Sometimes — if you get a Qualifying Life Event or if you’re eligible for a private PPO that takes applications year-round. That’s why we map both.
Robert Adams
RKA Insurance Advisors • Private & Marketplace Health Coverage • 561-806-9913 • robert@rkainsuranceadvisors.com
