Marketplace insurers raised 2026 premiums by an average of 26 percent nationwide, but that number hides a sharp geographic split. Sticker prices rose by roughly 30 percent in the roughly 30 states that rely on the federal HealthCare.gov exchange, compared with about 17 percent in the states that run their own marketplace platforms. For a retiree who left a job before turning 65 and now buys coverage without an employer behind it, that split can mean paying hundreds of dollars more a month for reasons that have nothing to do with age, income or health history, only which state issued the plan.
A 13-Point Gap Between Two Kinds Of Marketplaces
The Affordable Care Act runs on two parallel systems. Roughly 30 states let the federal government operate their exchange through HealthCare.gov, while about 20 states and the District of Columbia run their own marketplace platforms and set additional rules on top of the federal framework. Both groups faced an identical shock heading into 2026: the enhanced premium tax credits, created under the American Rescue Plan in 2021 and extended through 2025, expired on December 31, 2025, and no extension has been enacted since. Insurers built that expiration into their 2026 rate filings, which is the main reason premiums climbed almost everywhere.
The size of the increase, though, tracked which kind of exchange a household used. The Peterson-KFF Health System Tracker’s review of insurer rate filings found sticker premiums climbing about 30 percent in HealthCare.gov states against about 17 percent in state-run marketplaces, a 13-point gap layered on top of an already large national increase. A related KFF review of the same filing season put the nationwide average at 26 percent and noted that roughly 22 of 24 million marketplace enrollees receive a subsidy that offsets part of any increase, which means the full sticker shock lands hardest on the minority who buy coverage without a tax credit. The underlying analysis of state-by-state filings is laid out in the Health System Tracker’s brief on the 2026 rate cycle.
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State Reinsurance Programs And Homegrown Premium Subsidies
Two mechanisms, both concentrated in state-run marketplaces, help explain why the gap runs in that direction. The first is reinsurance. Several states operate Section 1332 waiver programs that reimburse insurers for a share of their highest-cost claims, which lowers the premium insurers need to charge everyone else to cover those costs. Maryland’s reinsurance program, in place since 2019 and extended through 2028, has cut premiums by as much as 35 percent relative to what they would otherwise be, according to the state’s own findings as compiled by KFF. Colorado and New Jersey report their reinsurance programs reducing statewide unsubsidized premiums by roughly 20 percent, with larger effects in rural rating areas, while Georgia’s and Oregon’s programs have each lowered unsubsidized premiums by at least 10 percent.
The second mechanism is a direct, state-funded subsidy layered on top of whatever federal tax credit still applies. New Mexico is backfilling the entire lost federal subsidy for enrollees up to 400 percent of the federal poverty level and capping premium payments for a benchmark plan at 8.5 percent of income for higher earners, mirroring the structure the enhanced federal credits used before they lapsed. Maryland is replacing the full lost subsidy for enrollees below 200 percent of the poverty level, California is doing the same below 150 percent, and Colorado and Washington are each providing flat monthly dollar amounts that offset part, though not all, of the increase. Every one of those programs runs through a state-based marketplace. HealthCare.gov states have no equivalent state-funded backstop of their own.
What Rate Regulators And Insurer Competition Could Not Confirm
Two other explanations are often raised for why premiums vary so much by state, and this reporting could not independently confirm either one for the current rate cycle. Some state insurance departments have the legal authority to reject or scale back a requested rate increase before it takes effect, while others can only review filings without the power to force a change. Whether that authority was actually exercised against 2026 filings, and in which specific states, was not verifiable from the sources reviewed here. The number of insurers competing within a given rating area also affects what any single carrier can charge, and state-run marketplaces are sometimes described as having retained more competing carriers than federally run ones. A state-by-state insurer count for the 2026 plan year was not available in the material reviewed for this article. Both factors are plausible contributors to the gap. Neither is established as a cause here, and no ranking of the four possible explanations is intended.
Why A Retiree’s State Now Shapes The Bridge To Medicare
The practical effect falls hardest on a specific kind of household: someone who retired or left a job before 65, does not yet qualify for Medicare, and buys an individual marketplace plan to cover the years in between. That household’s premium now depends heavily on whether a reinsurance pool and a state subsidy exist where it lives, separate from its income or health history. A retiree in Maryland or New Mexico buys coverage backed by a reinsurance program and, depending on income, a state subsidy stacked on top of whatever federal tax credit remains. A retiree with the same income and the same health profile in a HealthCare.gov state has neither backstop, and rate filings in that state built roughly a 30 percent increase, not 17 percent, into 2026 premiums.
That geographic advantage is not new this year. A broader KFF look at 2026 enrollment found that state-based exchanges, many of which are the same ones running reinsurance and supplemental subsidy programs, tended to retain a higher share of enrollees through the early months of the year than states relying on the federal platform, even as sign-ups fell nationwide. For a household bridging the gap between an early retirement and Medicare eligibility at 65, that finding is a reminder that the marketplace is not one national product with one national price. Which version of it a retiree happens to live under is now worth real money.
This article was produced with the assistance of AI and reviewed by The Financial Wire editorial team.
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David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
