Expect health insurance prices to rise next year, brokers and experts say

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Expect health insurance prices to rise next year, brokers and experts say

2025-08-25 13:00 Last Updated At：13:11

Pricey prescriptions and nagging medical costs are swamping some insurers and employers now. Patients may start paying for it next year.

Health insurance will grow more expensive in many corners of the market in 2026, and coverage may shrink. That could leave patients paying more for doctor visits and dealing with prescription coverage changes.

Price increases could be especially stark in individual coverage marketplaces, where insurers also are predicting the federal government will end some support that helps people buy coverage.

“We’re in a period of uncertainty in every health insurance market right now, which is something we haven’t seen in a very long time,” said Larry Levitt, an executive vice president at the nonprofit KFF, which studies health care.

In conference calls to discuss recent earnings reports, insurers ticked off a list of rising costs: More people are receiving care. Visits to expensive emergency rooms are rising, as are claims for mental health treatments.

Insurers also say more healthy customers are dropping coverage in the individual market. That leaves a higher concentration of sicker patients who generate claims.

Enrollment in the Affordable Care Act’s insurance marketplaces swelled the past few years. But a crackdown on fraud and a tightening of eligibility verifications that were loosened during the COVID-19 pandemic makes it harder for some to stay covered, Jefferies analyst David Windley noted.

People who use little care “are disappearing,” he said.

Prescription drugs pose another challenge, especially popular and expensive diabetes and obesity treatments sometimes called GLP-1 drugs. Those include Ozempic, Mounjaro, Wegovy and Zepbound.

“Pharmacy just gives me a headache, no pun intended,” said Vinnie Daboul, Boston-based managing director of the employee benefits consultant RT Consulting.

New gene therapies that can come with a one-time cost of more than $2 million also are having an impact, insurance brokers say. Those drugs, which target rare diseases, and some newer cancer treatments are part of the reason Sun Life Financial covered 47 claims last year that cost over $3 million.

The financial services company covers high-cost claims for employers that pay their own medical bills. Sun Life probably had no claims that expensive a decade ago and maybe “a handful at best” five years ago, said Jen Collier, president of health and risk solutions.

Some of these drugs are rarely used, but they cause overall costs to rise. That raises insurance premiums.

“It’s adding to medical (cost growth) in a way that we haven’t seen in the past,” Collier said.

Price hikes will be most apparent on the Affordable Care Act’s individual coverage marketplaces. Insurers there are raising premiums around 20% in 2026, according to KFF, which has been analyzing state regulatory filings.

But the actual hike consumers see may be much bigger. Enhanced tax credits that help people buy coverage could expire at the end of the year, unless Congress renews them.

If those go away, customer coverage costs could soar 75% or more, according to KFF.

Business owner Shirley Modlin worries about marketplace price hikes. She can’t afford to provide coverage for the roughly 20 employees at 3D Design and Manufacturing in Powhatan, Virginia, so she reimburses them $350 a month for coverage they buy.

Modlin knows her reimbursement only covers a slice of what her workers pay. She worries another price hike might push some to look for work at a bigger company that offers benefits.

“My employee may not want to go to work for a large corporation, but when they consider how they have to pay their bills, sometimes they have to make sacrifices,” she said.

Costs also have been growing in the bigger market for employer-sponsored coverage, the benefits consultant Mercer says. Employees may not feel that as much because companies generally pay most of the premium.

But they may notice coverage changes.

About half the large employers Mercer surveyed earlier this year said they are likely or very likely to shift more costs to their employees. That may mean higher deductibles or that people have to pay more before they reach the out-of-pocket maximum on their coverage.

For prescriptions, patients may see caps on those expensive obesity treatments or limits on who can take them.

Some plans also may start using separate deductibles for their pharmaceutical and medical benefits or having patients pay more for their prescriptions, Daboul said.

Coverage changes could vary around the country, noted Emily Bremer, president of a St. Louis-based independent insurance agency, The Bremer Group.

Employers aren’t eager to cut benefits, she said, so people may not see dramatic prescription coverage changes next year. But that may not last.

“If something doesn’t give with pharmacy costs, it’s going to be coming sooner than we’d like to think,” Bremer said.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Syrians mourn a former chess champion as her death is confirmed 13 years later

DAMASCUS, Syria (AP) — Hundreds of people have flocked to a tent in Damascus to mourn a former national chess champion who went missing 13 years ago along with her husband and six children, now that their deaths in Syria's civil wa r have finally been confirmed.

Surviving relatives of Rania al-Abbasi announced Sunday that they had seen evidence that she and her family had been killed by pro-government gunmen shortly after they were detained in 2013, and that they would set up a giant tent in the city on Tuesday and Wednesday to receive condolences.

“We had hope. We’ve been looking for them for 13 years in every way possible,” Rana's brother Wael al-Abbasi said in an interview with The Associated Press. “Then we got the horrible news that they were killed the same day they were arrested.”

The case of Rana al-Abbasi, who also was a dentist and who had been accused of funding the opposition, was well-known in Syria, and this week's revelations have received wide coverage in the country's news media. Photos of the family have been all over social media. Many people have said the killers should be sentenced to death.

Mohammad Shukri, Syrian minister of religious affairs, visited the tent in the Rukneddine neighborhood on Tuesday and said the country's new government is making sure that the culprits are held accountable. “They must get their punishment,” he said.

More than 100,000 people went missing in areas once controlled by forces loyal to now-ousted President Bashar Assad and many are believed to have died under torture run by the country’s powerful security agencies. The number could be higher, because many Syrians were too scared to complain under Assad, now in self-exile in Russia. Some people are now coming forward requesting information about missing loved ones.

During the early years of Syria’s conflict, which started with pro-democracy protests and later became a civil war, many people were killed, and the fate of many remains unknown. The conflict left nearly half a million people dead.

The fate of the al-Abassi family was revealed following the arrest of an ex-intelligence officer, who allegedly was involved in the killings, surviving family members said. Amjad Yousef had appeared in a video leaked four years ago that purportedly showed him and his comrades fatally shooting dozens of people during the country’s civil war.

Al-Abbasi’s family was shown another video that was not made public showing the children dead after apparently being strangled or beaten to death.

Wael al-Abbasi said that his brother-in-law, Abdul-Rahman al-Yassin, was detained on March 9, 2013 while his wife and children were detained four days later.

“We were holding on to hope to find one or two of the kids (alive),” he said.

Yousef, the ex-intelligence officer, was arrested by Syria's new authorities in April in the central province in Hama where he had been hiding. He has been undergoing questioning since then.

Wael al-Abbasi said he and other relatives saw a video in which Yousef was talking and pointing the camera at the children in a dark room that may have been part of a detention center.

“He was filming the kids and naming each one of them. Those were our kids, there was no room for doubt that it’s them, they were even wearing the same clothes,” he said.

The children’s ages were from 1 1/2 to 14. They were identified as Ahmad, Dema, Najah, Intisar, Alaa and Layan. He said a couple of them had their faces bloodied.

The brother said he hoped that Yousef and others involved in the killings would go on trial and be hanged. “They’re criminals and we have proof of that through videos. We want the whole chain, all the way up to Bashar Assad. We want them all to hanged.”

Since the fall of Assad, several top officials in his government and security agencies have been detained and some have been put on trial.

Al-Abbasi’s cousin, Doa’a al-Abbasi, said that the family had been worried that the children might have been trafficked, but now they know the truth.

“What is this brutality? What is this hatred? They waited for them to come home from school so he can kill them,” she said, referring to the children. “There are many people like Amjad Yousef and we hope they will all be held accountable."