Questions billers ask › What is the 2026 ACA premium adjustment percentage?

What is the 2026 ACA premium adjustment percentage?

Answered from the public Medicare sources on 2026-09-15. The quoted text is the source; the note beneath it is what our AI found. You decide what applies to your claim.

The rule, word for word

“We are finalizing a premium adjustment percentage of 1.6726771319 for PY 2026 based on the change to the premium measure for calculating the premium adjustment percentage that we are finalizing in this rule. Under § 156.130(e), we are finalizing the use of average per enrollee private health insurance premiums (excluding Medigap and property and casualty insurance), instead of ESI premiums, which were used in the calculation since PY 2022, for purposes of calculating the premium adjustment percentage for PY 2026 and beyond. The annual premium adjustment percentage sets the rate of change for several parameters detailed in the ACA, including the annual limitation on cost sharing (defined at § 156.130(a)); the reduced annual limitations on cost sharing; the required contribution percentage used to determine eligibility for certain exemptions under section 5000A of the Code (defined at § 155.605(d)(2)); and the employer shared responsibility payments under sections 4980H(a) and 4980H(b) of the Code. As explained in the 2025 Marketplace Integrity and Affordability proposed rule, our policy to use private health insurance premiums (excluding Medigap and property and casualty insurance) in the premium adjustment percentage calculation will result in a higher overall premium growth rate measure than if we continued to use ESI premiums as was used for prior plan years and in the [...]”

Federal Register, document 2025-11606, § 156.130(e) (15. Premium Adjustment Percentage Index (§ 156.130(e)))
Published2025-06-25 Captured2025-06-25
sha256:5c986fe5…7046d190 · Source

What our AI found in the sources

The 2026 premium adjustment percentage under the ACA is 1.6726771319. This percentage reflects the growth in average per enrollee private health insurance premiums (excluding Medigap and property and casualty insurance) from 2013 ($4,714) to 2025 ($7,885), representing approximately 67.3 percent growth over that period. CMS finalized a methodology change for 2026 and beyond to use this broader private health insurance premium measure instead of the employer-sponsored insurance (ESI) premiums used in prior years.

Also cited

Federal Register, document 2025-11606, Table 6 (Table 6—Final Premium Adjustment Percentage Index and Related Payment Parameters for the PY 2026)
Published2025-06-25 Captured2025-06-25
sha256:5c986fe5…7046d190 · Source

Federal Register, document 2025-11606, § 156.130(e) (2. Premium Adjustment Percentage (§ 156.130(e)))
Published2025-06-25 Captured2025-06-25
sha256:5c986fe5…7046d190 · Source

If this comes up on one of your claims

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