UNH Healthcare Vitals: Health Insurance Premiums Are Skyrocketing for 2026 – Why?
Did you Know?
Premiums and out-of-pocket expenses for healthcare insurance are going up, a lot! Most people and businesses purchasing healthcare insurance for 2026 will see a significant and alarming increase in the cost of premiums and out-of-pocket expenses. Why? And what can we do about it in New Hampshire?
Here is the problem…!
Health Insurance Companies Forecasting Double Digit Premium Increases
Health insurance companies are forecasting double digit increases in premiums for 2026. People enrolled in health insurance through large and small group employer plans as well as in plans available through the New Hampshire Insurance Marketplace (often referred to as ACA plans) will all experience large jumps in premium rates. In fact, the ACA Marketplace insurers across the country are raising rates by about 20% on average, and the median premium rate is about 11% higher than last year.
Here’s the Reason..
What’s the Reported Reason for the High Increase in Costs?
The health insurance plans report these substantial increases result from the escalating costs of health care and the impact of federal policy changes, offering the following explanations:
Enhanced Premium Tax Credits Are Going Away: Enhanced premium tax credits, making health insurance more affordable for most people on the ACA Marketplace exchanges, are set to expire at the end of 2025.1 “This expiration is expected to increase out-of-pocket premium payments for subsidized enrollees by over 75% on average.” Insurers predict that healthier people simply won’t buy health insurance due to the expense, resulting in a sicker and more expensive risk pool, exacerbating the problem.
Rising Rx Drug Costs: Increasing costs of hospital and physician care continue to push prices up. But for 2026, most insurers warn that the unexpectedly high use of expensive specialty Rx drugs, like GLP-1s (approved for treating Type 2 diabetes and obesity), is costing millions and putting the greatest strain on healthcare budgets.
Hospital Consolidation and Workforce Shortages: Insurers have blamed the consolidation of the hospital industry and labor market pressures as reasons for increasing costs for hospital services. In the ongoing contract negotiations between health insurance companies and hospital systems, the bigger the system, the higher the prices!
Federal Tariffs: Tariffs are a tax on goods that health insurance companies see impacting the medical supply chain in many ways including increasing costs for medical supplies, pharmaceuticals and other medical products. The insurance companies pass these unpredictable costs on to their customers.
Federal Policy Shifts: New rules on Marketplace insurance effective August 25 and the One Big Beautiful Bill Act (OBBBA) (enacting significant changes to healthcare related tax and spending provisions), will make it more difficult for many people to enroll in affordable health insurance. The result? Health insurance will be more expensive because health insurance carriers react to imminent uncertainty and a likely reduction in the number of healthy people in Marketplace plans by raising premiums.
When health insurance is not affordable, everyone suffers. Employers react by shifting more cost onto employees, patients pay more out-of-pocket and medical bills go unpaid. If healthy people don’t enroll in insurance, the costs will be driven higher, resulting in the ‘death spiral’ of escalating premiums the Affordable Care Act was meant to alleviate. So, New Hampshire, what’s the plan?
What does this mean for New Hampshire?
Health Insurance Premiums are Going Up for the Granite State– Especially if Enhanced Premium Tax Credits Go Away
Individuals seeking NH Marketplace Insurance are bracing for the impact of higher premiums during open enrollment beginning November 1, 2025. And without enhanced premium tax credits available through healthcare.gov, the impact will make purchasing insurance for many simply unaffordable.
For the 2025 coverage year, 70,337 Granite Staters selected health insurance plans through the New Hampshire Marketplace, with the vast majority receiving premium tax credits to lower costs. If the enhanced premium tax credits go away, “a couple in their early 60s earning $90,000 could see their annual premiums jump by over $14,000.”
For employers and employees in New Hampshire, the story is the same - premiums are going up by double digits on average. Rates are predicted to rise for small employers on healthcare.gov by about 7.5% (low) to 20% (high) depending upon the plan and company.
The NH Insurance Department is concerned, and urged health carriers to submit revised, data-driven rates for 2026, considering the expiration of federal subsidies, and federal and state policies putting upward pressure on costs.
Rising Prescription Drug Costs in New Hampshire
Prescription drugs are a leading driver of rising insurance premiums in New Hampshire. In 2024, commercial health plans and their members spent $1.33 billion on prescription drugs dispensed at retail pharmacies alone. The bulk of that spending was concentrated on a small number of high-cost specialty drugs, in fact 46% of pharmaceutical spending is on expensive specialty medicines and that percentage increases every year.
In New Hampshire, of the top 6 drugs by total spending, three were GLP-1s for diabetes and weight loss - together accounting for more than half of the total amount spent.
The pressure from the use of these high-cost drugs is not limited to commercial insurance. In New Hampshire’s public employee plans (excluding Medicaid), Ozempic, Wegovy, and Mounjaro also rank among the top five by spending - even though they only entered formularies in the past few years.
For New Hampshire, the rapid uptake of these high-cost specialty therapies will push insurance rates higher in 2026 and beyond. In fact, the New Hampshire Insurance Department’s 2024 report on premium cost drivers reinforces this picture: pharmacy accounted for more than one-fifth of overall medical trend in the group markets, and specialty drugs represented 54% of pharmacy spending. In the individual market, pharmacy costs spiked nearly 13% in a single year, underscoring how the rapid uptake of high-cost drugs like GLP-1s directly translates into higher premiums for New Hampshire families and taxpayers.2
Without policy action, the math ensures tomorrow’s premiums will bear the weight of today’s drug prices.
Hospital Consolidations and Affiliations – It’s a Thing in NH
Hospitals have been consolidating and rearranging ownership structures frequently across New Hampshire, straining affordability for patients, employers and taxpayers, and confusing anyone seeking to navigate healthcare choices and budgets for their families.
Just in the past few years, out-of-state hospital systems have been moving into the Granite State. HCA Healthcare, Inc. of Nashville, the largest hospital system in the US, purchased Catholic Medical Center assets resulting in the ownership of 4 for-profit hospitals across the Southern and Seacoast areas. Massachusetts based hospital systems formed Exeter Beth Israel Lahey Health in 2023, and Wentworth Douglass Mass General Bringham in 2016. In addition, most New Hampshire non-profit community hospitals have consolidated. Most recently Littleton Regional Healthcare announced its intent to join Dartmouth Health, and Elliot and Southern New Hampshire Health Systems proposed dissolving SolutioNHealth resulting in unknown costs (or savings) to communities.
Often communities are left in the dark about the actual impact of the consolidation on their healthcare and health costs - for example, almost immediately after HCA ‘purchased” assets of CMC earlier this year, HCA demanded “higher-than average prices” from health insurance plans, and proposed to duplicate existing services in both Concord and Nashua by building “free-standing emergency rooms” in order to attract patients to their for-profit hospitals. According to publicly reported data, HCA operates the highest priced hospitals in New Hampshire. See Sage Transparency 2.0, RAND/NASHP
And So… What do We Do?
Healthcare will become more expensive and health insurance more difficult to navigate for employers, families, health providers and tax payers into the future due to ongoing hospital consolidation, rising prescription drug costs, the impact of federal policy changes on access to insurance, workforce shortages and tariffs.
What can be done to help New Hampshire weather the impact?
Support enhanced premium tax subsidies at the federal level.
Resource New Hampshire’s health insurance navigators to ensure trained navigators can exist and assist consumers to answer questions about and enroll in health insurance.
Offer input into the NH Attorney General’s review of healthcare hospital consolidation and realignment.
Encourage review by the NH Healthcare Consumer Protection Commission of healthcare consolidation and trends impacting consumers.
Attend the 2025 Annual Hearing on healthcare Premium and Claim Cost Drivers on October 24, 2025, and ensure the New Hampshire Insurance Department engages in intentional review of the skyrocketing premium rates and the basis for the Rx drug and medical trends in order to recommend solutions that work for NH families.
Ask questions of your Human Resources/Benefits administrators and your healthcare providers about how to make it easier for you and your family to afford the healthcare you need.
Compare the estimated cost for certain health services on the NH Health Cost website when you are making choices about healthcare and to find out about trends and issues in your area.
Join the conversation with NH Health Cost Initiative.
- Lucy Hodder
