Health Insurance in 2026: Higher Costs, New Rules, and How to Stay Covered
The Story Behind the Changes
For many Illinois families, the last few years have been a rollercoaster of coverage options, premium shifts, and political whiplash. In the wake of the pandemic, expanded ACA subsidies, Medicaid protections, and easier enrollment rules made health insurance feel, for once, more accessible and affordable. But as 2025 came to a close, that stability began to shake.
Congress passed what’s been unofficially dubbed the “One Big Beautiful Bill,” a sweeping piece of legislation that extended some tax breaks while quietly rolling back the healthcare support systems many working-class Americans came to rely on. Combined with global supply chain shifts and a surge in prescription drug tariffs, 2026 is shaping up to be a year of change—some planned, others reactive.
So, what exactly is changing in your health coverage next year? Here’s what you need to know to stay ahead.
1. ACA Premiums Expected to Rise Sharply
The biggest headline: the expiration of enhanced ACA subsidies at the end of 2025. These subsidies helped millions afford marketplace plans—but unless Congress acts again, they’ll vanish in 2026.
Estimated premium increases: Up to 75% higher for some enrollees (Health System Tracker).
Middle-income families hit hardest: Especially those earning too much for Medicaid but not enough for unsubsidized plans.
2. Drug Costs and Import Tariffs Will Push Premiums Higher
New U.S. tariffs on imported prescription drugs are expected to ripple through the entire health system. While intended to stimulate domestic production, they will likely cause short-term increases in medication costs.
Impact: Higher drug prices = higher plan costs for both employers and individuals (KFF).
3. CMS Rule Will Offer Modest Savings—but Not Enough to Offset Increases
The Centers for Medicare & Medicaid Services is introducing a rule to reduce premiums by about 5% for most ACA marketplace plans.
Helpful, but limited: Won’t fully offset the impact of lost subsidies or rising medical inflation (CMS.gov).
4. Medicaid Eligibility Will Be Harder to Maintain
Twice-a-year income verification: New rules require more frequent checks.
Possible co-pays up to $35: Introduced for some non-emergency services.
Illinois may scale back state-funded options due to national funding reductions (My Journal Courier).
5. Enrollment Windows May Get Shorter and More Complex
Some federal proposals aim to shorten the open enrollment period and add penalties for passive re-enrollment.
Proof of income, address, and ID will be more tightly monitored (Politico).
How You Can Prepare
✅ Action💡 Why It MattersEnroll early (Nov 1–Jan 15)Beat any shortened deadlines and lock in a planUse subsidy calculatorsKnow what you’ll pay if subsidies expireKeep documents organizedPrevent coverage gaps due to new verificationsConsider HSA-eligible plansGain tax advantages and plan flexibilityStay informedWatch for any extension or rollback updates
Final Word
The healthcare landscape in 2026 will look different—but it doesn’t have to catch you off guard. By understanding the forces behind these changes and taking early action, you can protect your health, your wallet, and your peace of mind. As coverage becomes more complex, one thing remains clear: staying informed is your best defense.
