U.S. health insurers have asked regulators for the steepest premium increases on Affordable Care Act marketplace policies in eight years. Rate filings reviewed by health-policy research group KFF show carriers are seeking a median premium jump of 15% for 2026 coverage, surpassing the single-digit increases seen since 2019. The analysis of 105 insurers across 19 states and Washington, D.C. found most applications call for double-digit hikes, with nearly 30 insurers requesting increases of 28% or more. Major marketplace providers such as Centene, Elevance Health and UnitedHealth are among those proposing sizable adjustments as they grapple with cost pressures. Insurers cite several drivers: underlying medical costs are still rising roughly 8% a year; the pandemic-era premium tax credits that have tempered consumer payments expire at the end of 2025; and a 145% tariff on imported medical goods, alongside higher prices for GLP-1 weight-loss and diabetes therapies, is adding to expenses. Companies also point to an influx of higher-risk patients and compliance costs linked to the new “ACA Integrity Rule.” State and federal regulators must vet the requests before rates are finalized this autumn, and the final figures could be scaled back. Nonetheless, the proposed increases signal higher out-of-pocket costs for millions of marketplace enrollees and come as several insurers have already suspended or trimmed earnings guidance amid mounting medical-cost inflation.