Affordable Care Act premiums are set to skyrocket in Maine in 2026, and some enrollees could see even steeper increases if Congress doesn’t act.
Premiums will increase an average of 23.9% on the ACA individual marketplace, which has about 71,000 enrollees in Maine. The Maine Bureau of Insurance finalized the rate increases this week, ahead of open enrollment, which runs from Nov. 1 to Jan. 15.
Nationally, rates are going up by an average of 20%, according to KFF, a national health policy think tank.
Officials say the premium increases are being driven by the overall spike in the cost of health care, higher costs for prescription drugs and uncertainty in whether Congress will extend some ACA subsidies.
Premiums vary widely depending on income, age and the plan chosen, but individual plans can typically be purchased for about $100 to $300 per month. Maine’s rate hike is up compared to this year, when premiums increased an average of 8.6%.
On top of the premium increases approved by the Maine Bureau of Insurance, some enrollees could see their premiums double or more if Congress doesn’t extend subsidies, called Enhanced Premium Tax Credits. The subsidies, which were first established in 2021, are set to expire at the end of 2025.
The enhanced subsidies reduce premiums primarily for some lower-income populations and those earning more than 400% of the federal poverty level, which for a family of two would be a household income of more than $84,000.
Attempts to extend the subsidies appear to be gaining some momentum in Congress, but face an uncertain future.
Republican Sen. Susan Collins of Maine says that she supports extending the insurance premium tax credits.
“The nonpartisan Congressional Budget Office has estimated that allowing their expiration would cause nearly 4 million Americans to go without insurance coverage, which is the last thing I want to see happen,” Collins said in a written statement Thursday. “There are other estimates, including by the respected National Association of Insurance Commissioners, that huge premium increases would occur. Many Maine families cannot afford insurance without these tax credits.”
Reps. Chellie Pingree, D-1st District, and Jared Golden, D-2nd District, and Sen. Angus King, I-Maine, also support the extension.
About 85% of ACA enrollees in Maine receive at least some enhanced subsidies, according to state enrollment data. The subsidies also cap the maximum a family can pay in premiums to 8.5% of household income.
Maine Gov. Janet Mills said in a written statement Thursday that “lives depend on affordable health coverage.”
“Rural families, early retirees, and the self-employed will be among the hardest hit if these credits expire,” Mills said.
Bob Carey, superintendent of the Maine Bureau of Insurance, said in a phone interview Thursday that if the tax credits expire it could lead to about 30,000 Mainers becoming uninsured. One group that will be especially harmed, Carey said, are those nearing retirement, but aren’t yet old enough to qualify for Medicare, which kicks in when they turn 65.
“An older couple, say they make $85,000, they are going to get whacked with a huge insurance bill,” Carey said. “Their premiums could be $25,000 (per year). It’s going to probably be unaffordable for them.”
Carey said the uncertainty about whether the credits will expire is part of what’s driving the nearly 24% average premium increase.
In addition to the individual market, premiums will rise by an average of 17.5% in Maine for the small-group market, which is for businesses with fewer than 50 employees. The small-group market has about 45,000 enrollees in Maine.
The uncertainty will also likely prevent some people from starting their own businesses, Carey said, if their ACA insurance would be unaffordable compared to getting employer-based insurance.
“This would be a real brake on economic development, entrepreneurship and job creation,” Carey said.
