Axis Intelligence Research · Pricing benchmark · Employer plan vs Marketplace comparator

Health Insurance Cost 2026

Axis Intelligence Research · co-author David Park · updated October 3, 2026 · source & dataset

PRICES VERIFIED OCT 3, 2026

KFF · CMS · IRS · HHS · DOL · 200 SOURCED ROWS · CC BY 4.0

+57.5%

What Marketplace enrollees actually pay jumped in 2026: the average premium after tax credits rose from $113 to $178 a month once the enhanced credits expired on January 1.The sticker price moved less: the age-40 benchmark rose 25.8%, from $497 to $625. Sources: CMS 2026 OEP Report; KFF.

Net 25

$113

Net 26

$178

Bench 25

$497

Bench 26

$625

Employer plan vs Marketplace: your premium-plus-deductible cost in 2026

Set household, age and income · results update live

Household

Family = two adults at the age below + two children under 15.

Age 40

Federal default ACA age curve (CMS/HHS). Age 64 pays 3.0× age 21.

Household income, USD —

Modified adjusted gross income for 2026. FPL uses the 2025 HHS guideline that governs 2026 coverage.

Employer: firm size

Marketplace plan

Silver applies cost-sharing reductions below 250% FPL. Bronze is never CSR-eligible.

Third option

Employer plan · PPDC

—

Marketplace · PPDC

—

Tax credit, 2026

—

Benchmark cap

—

COBRA PPDC

—

5-year gap

—

Marketplace minus employer, at 2026 prices

Where your income sits on the 2026 subsidy scale (% of FPL)

0%100%200%300%400% cliff530%+

Benchmark, age 40

$625

per month before subsidy · +25.8%

Paid after credits

$178

avg Marketplace enrollee · was $113

Employer family premium

$26,993

worker pays $6,850 · KFF 2025

PPDC ratio

3.85×

unsubsidized silver vs employer single

Subsidy cliff, age 60

$9,692

lost one dollar above $62,600

KFF · 2025 Employer Health Benefits Survey; Marketplace premiums 2026

CMS · 2026 Open Enrollment Report, Mar 27, 2026

IRS · Rev. Proc. 2025-25 · HHS · 90 FR 27074

All sources retrieved · Oct 3, 2026

The PPDC ladder · single adult, every way to buy coverage

Spread 4.0× · large-firm plan to unsubsidized silver

Premium paid by the householdDeductibleMultiple vs employer average ($3,326)

Premium-Plus-Deductible Cost (PPDC). PPDC = annual premium paid by the household + annual plan deductible. The money spent in a year before the plan pays for most care. Unsubsidized bronze looks cheaper on the monthly bill and ends up within $146 of benchmark silver once the deductible is counted.

The 2026 subsidy cliff · annual benchmark premium you pay, by income · single, age 40

Follows the household and age set in the comparator. Contribution = applicable percentage (IRS Rev. Proc. 2025-25) × income, capped at the full benchmark; credits end above 400% FPL. Benchmark = KFF $625 national average scaled by the federal age curve.

Single, age 40

$1,265

lost at $62,601 · benchmark $7,500

Single, age 60

$9,692

lost at $62,601 · benchmark $15,927

Single, age 64

$11,371

premium = 28.1% of income above the line

Family of four, 40s

$11,170

lost at $128,601 · benchmark $23,979

Who pays the employer premium · KFF 2025

Employer share, family 74.6%

Single coverage · $9,325 worker 16% · employer 84.6%

Worker $1,440

Employer $7,885

Family coverage · $26,993 worker 26% · employer 74.6%

Worker $6,850

Employer $20,143

The invisible paycheck. At KFF averages, 100 covered workers cost an employer $788,500 a year in single coverage and $2,014,300 in family coverage. Family premiums rose 26% in five years against 28.6% wage growth and 23.5% inflation.

Small firm vs large firm · same premium, different bill

Family contribution gap $2,662

Worker family contribution

10–199

$8,889

200+

$6,227

Single deductible

10–199

$2,631

200+

$1,670

Share of family premium paid

10–199

36%

200+

23%

Read the offer, not the plan summary. 28% of small-firm workers face a family contribution of $12,000 or more, and 53% carry a single deductible of $2,000 or more. Average family premiums are close: $26,054 at small firms, $27,280 at large ones.

Marketplace 2026 · what enrollees chose after the credits shrank

Plan selections 23.1M · −5%

Silver lost its majority. Silver selections fell from 56% to 43%; 43% of HealthCare.gov enrollees picked an HSA-eligible plan now that every bronze and catastrophic plan qualifies. Source: CMS Health Insurance Exchanges 2026 Open Enrollment Report.

Metal tier price check · age 40, monthly, 2026

KFF analysis of CMS data, weighted by county plan selections. The lowest gold ($615) is priced under benchmark silver ($625): silver carries the cost of cost-sharing reductions.

Benchmark premium by age · unsubsidized, 2026

Axis estimate: $625 × age factor ÷ 1.278, federal default curve. States with their own curves (MA, MN, NJ, OR, UT, DC) differ.

Price momentum · employer cost vs Marketplace rates

Employer: KFF family premium growth 2025; Mercer total cost per employee 2026 and 2027 projections. Marketplace: KFF median finalized rate change 2026, median proposed 2027 (276 insurers).

Cumulative PPDC · single, 1 / 3 / 5 years

Axis scenarios. Employer premium share at +5% (KFF) or +8.2% (Mercer); Marketplace age 40 unsubsidized held flat or +15% (KFF proposed 2027). Deductibles held flat.

The 2026 rulebook · federal parameters that set your price

Out-of-pocket cap +15.2%

Out-of-pocket max

$10,600 / $21,200

self-only / family · was $9,200 · HHS

Benchmark cap

9.96%

of income, 300–400% FPL · also the employer affordability test · IRS

Subsidy cliff

$62,600 / $128,600

400% FPL, 1 person / family of 4 · HHS 2025 guideline

COBRA ceiling

102%

of full plan cost, employer share included · DOL

FPL safe harbor

$129.89/mo

max affordable employee single contribution · IRS

Age rating

3.0×

age 64 vs age 21 · federal default curve

Medicare Part B

$202.90/mo

standard premium, +9.7% · $283 deductible · CMS

2027 outlook

+15% / +8.2%

Marketplace proposed median / employer cost · KFF, Mercer

Applicable percentage table, 2026. The share of income a household pays for the benchmark plan, rising within each band from the initial to the final percentage. Above 400% FPL there is no credit. Source: IRS Rev. Proc. 2025-25, Section 3.01.

Full price benchmark · click a header to sort

Highest single PPDC $12,804 unsubsidized silver

Channel	Tier	Premium / mo	Premium / yr	Deductible	PPDC	vs employer	Source
Sources: KFF 2025 Employer Health Benefits Survey (premiums, worker contributions, deductibles by firm size and plan type); KFF analysis of CMS Marketplace data, 2026 (age-40 premiums by metal tier); Peterson-KFF Health System Tracker (2026 metal-level deductibles); CMS Health Insurance Exchanges 2026 Open Enrollment Report (premium after tax credits); KFF (2026 average Marketplace deductible); U.S. Department of Labor (COBRA 102% rule). Employer firm-size premium shares and all PPDC values calculated by Axis Intelligence Research. Rows without a published deductible show premium only.