Texas health insurance consumers are facing a perfect storm in 2026, with ACA Marketplace premiums poised to skyrocket by an average of 34.7% — a financial blow that will hit millions of residents just as enhanced federal subsidies disappear.
The double whammy comes as enhanced Affordable Care Act premium tax credits are set to expire on December 31, 2025, causing what enrollees actually pay to more than double for most of the 22 million subsidized enrollees nationwide. According to a Kaiser Family Foundation analysis, the average increase in consumer costs will be a staggering 114%.
Texas Facing Steeper Increases Than National Average
The situation in Texas looks even more dire. Insurance carriers across the state have filed for premium increases that significantly outpace the national trend, with rate filings showing an average jump of 34.7% — nearly double the 18% median increase expected nationally.
Blue Cross Blue Shield of Texas, the state’s largest health insurer, has proposed some of the steepest hikes. Their Blue Advantage HMO plans would increase by 39.4%, while Blue Advantage Plus POS plans face a 38.4% jump. The insurer confirmed these new rates would take effect January 1, 2026, citing “rising costs and policy changes” as primary factors.
What’s driving these astronomical increases? The expiration of enhanced subsidies accounts for about 4 percentage points of the premium hikes nationwide, but Texas insurers appear to be building in additional cushion for market uncertainty.
Baylor Scott & White Health Plan has also acknowledged their monthly premiums for ACA plans will increase in 2026 specifically due to the subsidy expiration, though they haven’t yet revealed by how much.
A Growing Uninsured Crisis?
The timing couldn’t be worse for Texas, which has seen remarkable growth in marketplace enrollment — from 1.1 million in 2020 to approximately 4 million in 2025. Those gains now appear threatened.
“You get left with a pool of people that are covered that are older or sicker and have higher healthcare costs and needs,” health policy expert Hudson warned in a recent interview with public radio.
The potential domino effect is concerning: higher uninsured rates, sicker risk pools, and increased pressure on emergency rooms as people lose coverage and delay care until conditions become severe.
Is there any silver lining? Perhaps a small one. According to Texas 2036, a nonpartisan policy organization, about 75% of Texas ACA enrollees — roughly 3.1 million people with incomes below 200% of the federal poverty level — will still have access to at least one zero-premium plan despite the rising costs. The group estimates these lower-income enrollees will be somewhat insulated from the full impact of the subsidy cliff.
But for middle-income Texans making between 200% and 400% of the federal poverty level, the financial hit will be substantial. A family of four earning $120,000 could see their monthly premiums jump by hundreds of dollars overnight.
The premium increases aren’t uniform across all plans or regions. Some insurers in other states have filed for more modest increases, or even decreases, with national filings ranging from a 10% reduction to a 59% increase. But Texas consistently falls on the high end of that spectrum.
With just over a year before these changes take effect, health advocates are already warning of potential coverage losses. Without congressional action to extend the enhanced subsidies, Texas — which already leads the nation in uninsured residents — may see its health coverage gains of recent years rapidly unravel in what some policy experts are calling a looming affordability crisis.
