Rising medical costs may lead to higher health insurance and coverage changes in 2026
TL/DR –
Rising prescription costs and increasing medical expenses are burdening insurers and employers, which may result in patients bearing more costs in 2026. Health insurance may increase in price and cover less, possibly causing patients to pay more for doctor visits and prescriptions. Causes of these impending increases include a higher concentration of sicker patients as healthier ones drop coverage, high-cost treatments for diabetes and obesity, pricey gene therapies, and possible cuts to the federal government’s support for health coverage.
Rising medical costs burden insurers and employers
Surging medical expenses, including costly prescriptions, are currently overwhelming insurers and employers. This could impact patients in 2026 as they might face higher costs for medical services and prescription coverage. The affordability of health insurance is expected to plummet, particularly in individual coverage marketplaces as Federal support is predicted to cease.
Increased healthcare demand and reduced coverage
Insurers are facing rising costs due to an increase in healthcare demands, including costly emergency room visits and claims for mental health treatments. With healthy customers dropping their insurance, a higher number of sicker patients filing claims remain. This is further complicated by changes to eligibility for the Affordable Care Act (ACA)’s insurance markets, making it more difficult for some to maintain coverage.
Expensive prescription drugs add to challenges
The increasing cost of prescription drugs, especially diabetes and obesity medications like Ozempic, Mounjaro, Wegovy, and Zepbound, is another significant challenge. Novel gene therapies with hefty price tags, over $2 million in some cases, and new cancer treatments are contributing to the financial pressure on insurers. Despite being used infrequently, the overall cost of these drugs impacts insurance premiums.
Impending price hikes in ACA’s coverage marketplaces
Premiums are expected to rise around 20% in the individual coverage marketplaces of ACA in 2026. Consumers could face even more significant hikes if enhanced tax credits, which are due to expire, aren’t renewed by Congress. Without these tax credits, customer coverage costs could increase by an alarming 75%, causing concern for business owners like Shirley Modlin, who currently reimburses her employees for their insurance costs.
Employers may pass on costs to employees
The costs of employer-provided coverage have also been rising, leading to potential changes in health benefits. Many large employers are likely to shift more costs to their employees, resulting in higher deductibles or increased out-of-pocket maximums. There may also be changes to prescription coverage, with possible caps on obesity treatments as well as separate deductibles for pharmaceutical and medical benefits.
Potential changes to drug coverage
Changes to coverage may vary across the country and could include caps on certain treatments or limitations on who can receive them. While employers are reluctant to cut benefits, if pharmaceutical costs don’t decrease, dramatic changes to prescription coverage could occur sooner than anticipated.
—
Read More Health & Wellness News ; US News