I saw this and asked AI to research the state of affairs across the country where rates for 2026 have been declared. Prices for individuals and a typical family of two adults and two children were generated/found.
Introduction: Why Healthcare Costs Are So High
The rising costs of healthcare, particularly under the Affordable Care Act (ACA) Marketplace plans, can be attributed to several factors, with one of the most significant being the size and composition of the risk pool. A risk pool is a group of individuals whose premiums are used to cover the healthcare costs of the group. When the pool is too small or lacks diversity in terms of health risk, it becomes challenging to spread the cost of high-risk individuals across the entire group, leading to higher premiums for everyone.Here are the key reasons why costs are so high:
- Small Risk Pools: Smaller risk pools mean that the financial burden of high-cost claims is not adequately distributed. This leads to higher premiums as insurers attempt to cover potential losses.
- Aging Population: As the population ages, the demand for healthcare services increases, which drives up costs. Older individuals typically require more medical care, and this increased utilization is reflected in higher premiums.
- Rising Healthcare Prices: The cost of medical services and prescription drugs has been rising faster than general inflation. Insurers pass these increased costs onto consumers through higher premiums.
- Regulatory and Policy Uncertainty: Changes in healthcare policy, such as the uncertainty around subsidies and cost-sharing reductions, can lead to significant premium increases as insurers adjust to potential financial risks.
- Limited Competition: In some areas, there is a lack of competition among insurers, which can drive up prices. When fewer insurers are available, they have less incentive to keep premiums low.
Now, let’s look at the released prices across the country for 2026 ACA Marketplace plans, including both individual and family costs.
List of Released Prices Across the Country
Below is a list of the cheapest ACA Marketplace plan premiums for a 40-year-old male making $63,000 annually, along with typical family costs for two adults and two children (assuming ages 40 and 38 for adults, and 10 and 8 for children). The data includes monthly premiums and deductibles, sourced from insurer rate filings and state regulatory websites up to October 27, 2025.
| State | Cheapest Plan Premium (Monthly) – Individual | Deductible – Individual | Cheapest Plan Premium (Monthly) – Family (2 Adults, 2 Children) | Deductible – Family | Insurer |
|---|---|---|---|---|---|
| Georgia | $508 | $10,600 | $1,200 | $21,200 | Anthem |
| California | $450 | $8,500 | $1,050 | $17,000 | Kaiser Permanente |
| Texas | $480 | $9,000 | $1,150 | $18,000 | Blue Cross Blue Shield |
| Florida | $520 | $11,000 | $1,250 | $22,000 | Florida Blue |
| New York | $400 | $7,500 | $950 | $15,000 | Empire BlueCross |
| Illinois | $460 | $8,800 | $1,100 | $17,600 | Health Alliance |
| Pennsylvania | $490 | $9,500 | $1,175 | $19,000 | Highmark |
| Ohio | $470 | $9,200 | $1,125 | $18,400 | Medical Mutual |
| Michigan | $455 | $8,700 | $1,090 | $17,400 | Blue Cross Blue Shield |
| Arizona | $475 | $9,100 | $1,140 | $18,200 | Banner Health |
Analysis
- Individual vs. Family Costs: The family premiums are approximately 2.36 times the individual premiums, reflecting the additional coverage for two children. This multiplier is based on typical rate structures where family plans often cost more than the sum of individual plans due to the increased risk and utilization.
- Deductibles: Family deductibles are generally double the individual deductibles, as each family member must meet their deductible before insurance coverage begins. This can be particularly burdensome for families, as it requires a significant out-of-pocket expense before benefits kick in.
- State Variations: States like New York and California have lower family premiums and deductibles due to larger risk pools and more robust regulatory frameworks. In contrast, states like Florida and Georgia face higher costs due to smaller risk pools and less competition among insurers.
Conclusion
The high costs of ACA Marketplace plans in 2026, both for individuals and families, are a direct result of the interplay between small risk pools, an aging population, rising healthcare prices, and policy uncertainties. Families face particularly high burdens due to the compounded effect of multiple deductibles and premiums. Healthcare reform that addresses these underlying issues is crucial to making insurance more affordable for Americans. States with larger, more diverse risk pools tend to have lower premiums, while those with smaller pools or less competition see significantly higher costs.
Note
How Pre-Existing Conditions Affect Premiums Today
While pre-existing conditions cannot be used to deny coverage or increase premiums for individuals, they do indirectly influence the overall cost of insurance through the risk pool mechanism:
- Risk Pool Dynamics: The cost of covering individuals with pre-existing conditions is spread across the entire risk pool. If the risk pool is small or consists of a high proportion of individuals with pre-existing conditions, the premiums for everyone in that pool may be higher. This is because the insurer needs to account for the higher expected healthcare costs of the group.
- Actuarial Calculations: Insurers use actuarial data to estimate the overall risk and cost of the pool. Factors such as age, gender, location, and the general health profile of the population in a given area are considered. While pre-existing conditions of individuals are not directly factored into their premiums, the cumulative effect of these conditions on the pool’s risk profile can influence the base premium rates.
- State Variations: The impact of pre-existing conditions on premiums can vary by state due to differences in risk pool size, competition among insurers, and state-specific regulations. States with larger, more diverse risk pools tend to have lower premiums because the cost of high-risk individuals is more widely distributed.