WASHINGTON, D.C.: Health insurance is set to get more expensive in 2026, with higher premiums and shrinking coverage likely across multiple markets. Rising drug prices, surging medical claims, and shifting enrollment patterns are piling pressure on insurers, brokers say, and patients may end up bearing more of the costs.

The sharpest hikes are expected in the Affordable Care Act's individual marketplaces, where premiums could rise around 20 percent, according to analyses by the nonprofit KFF. If enhanced federal tax credits expire at year's end, coverage costs for some customers could skyrocket by 75 percent or more.

"We're in a period of uncertainty in every health insurance market right now, which is something we haven't seen in a very long time," said Larry Levitt, a KFF executive.

Insurers cite a long list of rising costs: emergency room visits are increasing, mental health treatment claims are up, and healthy enrollees are dropping coverage in the individual market, leaving sicker patients behind. Enrollment had swelled during the pandemic, but stricter fraud checks and tighter eligibility rules are now pushing some low-use consumers out.

Prescription drugs are another driver, particularly high-demand diabetes and obesity drugs like Ozempic, Mounjaro, Wegovy, and Zepbound. "Pharmacy just gives me a headache, no pun intended," said Vinnie Daboul, a managing director at RT Consulting.

The financial toll extends to gene therapies and specialized cancer treatments with price tags above US$2 million per patient. Sun Life Financial said it covered 47 employer claims exceeding $3 million last year, compared with almost none a decade ago. "It's adding to medical cost growth in a way that we haven't seen in the past," said Jen Collier, president of health and risk solutions at Sun Life.

Employers, who provide coverage for most insured Americans, are also feeling the squeeze. While they typically shoulder most premium costs, many are exploring ways to pass more expenses to workers. About half of the large employers surveyed by Mercer said they expect to shift costs, potentially through higher deductibles or greater out-of-pocket requirements.

Prescription benefits may also tighten. Some plans could impose caps on expensive weight-loss drugs or adopt separate deductibles for pharmacy versus medical benefits. "If something doesn't give with pharmacy costs, it's going to be coming sooner than we'd like to think," said Emily Bremer, president of The Bremer Group, an insurance agency in St. Louis.

For smaller businesses, the impact may be especially stark. Virginia business owner Shirley Modlin said she already struggles to help employees with premiums through a monthly reimbursement. "Another price hike might push some to look for work at a bigger company that offers benefits," she said.