ACA Premiums Jump 13% as AI Tools and Tariffs Add to Medical Costs
New data shows double-digit increases in insurance rates, while experts cite artificial intelligence billing practices and supply chain shifts as key drivers of the spike.
By Marco Kapoor ·
American voters face a steep increase in healthcare expenses ahead of Tuesday's midterm elections, with average benchmark premiums for Affordable Care Act plans set to rise by 13% next year. According to a KFF analysis released Friday, this marks the second consecutive year of double-digit percentage hikes in finalized silver plan costs. For 2026, the average monthly benchmark premium for ACA enrollees has climbed to $625, up from $497 in 2025, following the expiration of enhanced tax credits at the end of the prior year.
The trend extends beyond individual market plans to employer-sponsored coverage and prescription drugs. A KFF survey indicates workers are paying nearly 10% more for their premiums, while the average single-coverage deductible reached $1,886 in 2025, a 43% increase since 2015. Prescription drug spending grew by 12.7% in 2025 to reach $915 billion. The American Society of Health-System Pharmacists projects this figure will surpass $1 trillion in 2026. An AARP Public Policy Institute report found that the top 25 brand-name drugs have seen their prices rise by an average of 81% since their introduction to the U.S. market.
Experts point to the adoption of ambient artificial intelligence scribes in clinical settings as a recent factor driving up claims. These tools document visits and generate notes, which insurance companies and analytics firms say can lead to secondary diagnoses or billing mismatches. Zack Cooper, a public health professor at Yale University, noted that these AI tools facilitate more aggressive coding. Sabrina Corlette, a research professor at Georgetown University, described a recent check-up where an ambient scribe recorded a brief question, reclassifying the visit from preventive to diagnostic and triggering a co-payment she did not expect.
Tariffs on imported medical supplies represent another cost driver. A study from Georgia Tech and the University of California, Davis, calculated that federal tariffs on imported medical supplies totaled $3.4 billion in the first half of 2025. Approximately 56% of that amount was passed on to facilities and providers. The Food and Drug Administration estimates that 78% of active pharmaceutical ingredient manufacturers are located outside the United States, making the domestic supply chain vulnerable to global price fluctuations.
Industry stakeholders offer varying explanations for the cost increases. Chris Bond, a spokesperson for the Association of Health Insurance Plans, attributed rising premiums to anticompetitive practices by hospital monopolies and private equity-backed providers. Conversely, the American Hospital Association stated that corporate insurers are the primary drivers of cost increases due to their market dominance. The White House, citing Most Favored Nation drug pricing agreements, claims the administration has saved Americans over $1 billion on prescription medications.
The U.S. Department of Health and Human Services and various insurers continue to defend their use of automated tools. UnitedHealthcare stated that its predictive tools provide information rather than making adverse coverage determinations, while CVS said it uses AI to accelerate prior authorization approvals. These responses follow a 2024 Senate subcommittee report that found higher denial rates for post-acute care at several major insurers after the increased use of automated technologies.
