Why Your Health Insurance Costs Are Likely Going Up in 2026—and What You Can Do About It👉 Spoiler alert: your health insurance bill could look very different in 2026.Premiums are projected to jump

Why Your Health Insurance Costs Are Likely Going Up in 2026—and What You Can Do About It

👉 Spoiler alert: your health insurance bill could look very different in 2026.Premiums are projected to jump, employers are shifting more costs to employees, and prescription drugs are changing the math for insurers.

Sounds frustrating? It is. But here’s the good news: when you understand why costs are going up, you can actually take steps to protect yourself (and your business). Let’s break it all down.

What’s Driving the Cost Increases?

1. Marketplace (ACA) Plans

If you purchase insurance through the Affordable Care Act (ACA) Marketplace, here’s what you need to know:

• Premium Increases: Analysts warn of an average 20% rise in premiums in 2026 [AP News].

• Subsidy Cliff Ahead: The expanded subsidies created by the 2021 American Rescue Plan are set to expire at the end of 2025. If Congress doesn’t renew them, some families could see premiums spike by over 75%—especially middle-income households who currently qualify for reduced rates [AP News].

• Example: A family of four in Pennsylvania currently paying ~$400/month could suddenly face bills closer to ~$700/month if subsidies vanish.

👉 Translation: Plan ahead. If you’re on a Marketplace plan, don’t assume subsidies will always be there.

2. Employer-Sponsored Plans

For small businesses, health insurance is usually the second or third highest expense after payroll. Here’s what’s happening:

• Rising Premiums for Employers: Employers are facing the same medical inflation as individuals. Expect annual increases between 6–8% on average [AP News].

• Cost-Shifting to Employees: To offset expenses, many employers are increasing deductibles, co-pays, and coinsurance rather than absorbing higher premiums. That means more out-of-pocket costs for workers.

• Reduced Coverage: Some companies are scaling back benefits—cutting dental, vision, or reducing the employer contribution to dependent coverage.

• Example: A trucking company in PA paying $1,000 per employee per month may now only cover 60% instead of 75% of premiums, shifting hundreds of dollars per paycheck onto employees.

👉 Translation: Even if your premium doesn’t rise drastically, your coverage could shrink.

3. Prescription Drugs & Medical Innovations

Prescription drug costs are one of the biggest drivers of rising premiums.

• GLP-1s (Ozempic, Wegovy, Mounjaro, etc.): These new weight-loss/diabetes drugs can cost $12,000+ per year per patient. Insurers are building that cost into everyone’s premiums [AP News].

• Specialty Drugs: Treatments for cancer, autoimmune disorders, and genetic therapies regularly hit $50,000–$100,000+ annually. While only a small percentage of members use them, the costs are pooled across all policyholders.

• Utilization Increases: More people are accessing care post-pandemic, catching up on delayed procedures, screenings, and elective surgeries, which means insurers are paying out more.

👉 Translation: Even if you’re healthy, you’ll feel the ripple effect of high-cost medications.

4. Medical Inflation & Provider Shortages

It’s not just drugs—general healthcare inflation is at play.

• Hospital Costs: Staffing shortages (nurses, technicians, doctors) mean hospitals are paying more in wages and passing costs onto insurers.

• Delayed Care = Higher Costs: During COVID, many skipped screenings and preventive care. Now, they’re coming in with advanced conditions, which cost far more to treat [Axios].

• Primary Care Access: Many regions face shortages of primary care providers. Without access to affordable preventive care, patients end up in ERs, which are much more expensive [Axios].

👉 Translation: Rising medical bills are inevitable when the system is stretched thin.

Your Game Plan for 2026

The good news? You’re not powerless. Here’s how to prepare:

✅ Know Your Plan Inside Out

• Review your plan documents now.

• Understand what you’ll owe before you need care.

• Ask your HR rep or broker (like me 😉) to explain deductibles, coinsurance, and max out-of-pocket in plain English.

[Investopedia]

✅ Leverage HSAs & FSAs

• HSAs: Tax-deductible contributions, tax-free growth, and tax-free withdrawals for medical expenses. They roll over each year.

• FSAs: Funded with pre-tax dollars but usually "use it or lose it." Great for predictable expenses like glasses, dental, or prescriptions.

• If your employer offers a match—take it. That’s free money.

[Investopedia]

✅ Be Smart About Prescriptions

• Ask if a generic is available.

• Shop around—yes, pharmacies charge different prices for the same drug. Tools like GoodRx can help.

• Talk to your doctor about whether samples, assistance programs, or alternative therapies are available.

[Investopedia]

✅ Don’t Ignore Medical Bills

• Hospitals often have charity care or financial aid programs.

• Many will discount bills if you pay cash upfront or set up a payment plan.

• Ignoring bills can tank your credit—so make the call.

[Investopedia]

Final Word: Don’t Wait Until 2026 Hits

Yes, costs are rising. But you can still control how hard it hits you.

📌 Know your plan.📌 Use savings accounts wisely.📌 Shop smarter for prescriptions.📌 Negotiate when you need to.

The difference between being blindsided and being prepared could save you thousands in 2026.

💡 Need help reviewing your options? That’s exactly what I do. Let’s walk through your plan together and make sure you’re not leaving money on the table.

👉 Schedule a free consult with me here https://calendly.com/cherylh-thebenefitdoctor/30min