ACA Premiums Are Spiking Up to 43%. Here's What Self-Funded Employers' Claims Data Actually Shows

ACA premiums are spiking well above the industry's decade-long trend of sub-10% increases. Employers should watch these public filings as early warning signals for market pressures.

ACA Premium Filings by State: How High Are Insurers Actually Asking to Go?

Across the country, ACA insurers (the companies that sell health plans on ACA marketplaces) are  filing for some of the steepest premium increases in recent memory:

• Florida: Molina Healthcare requests 41% increase for 2026
• Georgia: United seeks 43% increase
• ‍Texas: United seeks 39% increase ‍
• Michigan: Carriers propose increases above 18%

Even traditionally stable Blues plans push for premium increases above 20% in multiple states.

The justification? Rising patient utilization. Worsening risk pools. Price inflation. In short: we should expect next year’s cost of care to rise...big time. ‍

ACA premiums are spiking over 40% in some states, while self-funded employers’ costs are holding steady at under 5%. That gap tells the real story.  

Nomi Health analyzed 12 months of real-world claims data from self-funded employers nationwide with this question in mind: Are the same trends driving up rates for self-funded employers?

Short answer: they're not.  
Longer answer: they’re not, yet.

Self-Funded vs. Fully Insured: What 2024 Claims Data Shows About Healthcare Costs

Our clients span every state in America, representing more than 20 million lives. The data from 2023-2024 shows a healthcare market that's far more stable than ACA premium filings suggest:

• Medical spend rose just 1.75% (per member per month)
• Pharmacy spend rose 8.64% (per member per month), largely driven by predictable growth in categories like GLP-1s
• Claim volume declined 2.17% (per 1k members)
• High-cost claimants above $100K increased 7.8% (anything 8% and below is considered normal)  

Here we see stable medical costs, declining claim volume, and predictable shifts in high-cost and catastrophic cases.

State-by-State: Self-Funded Costs vs. ACA Premium Increases

We dug deeper to see if national trends might mask regional volatility. But the national pattern holds locally. In fact, in the states where ACA carriers seek the most dramatic increases, our self-funded clients show modest, stable growth:

• Florida: 0.35% medical cost increase (while ACA carriers seek up to 41%)
• Texas: 1.8% increase (while ACA carriers seek up to 39%)
• Georgia: 4.08% increase (while ACA carriers seek up to 43%)
• Michigan: 4.45% increase (while ACA carriers seek 18%+)
• New Jersey: 6.43% increase (while public employers face 30%+ hikes)

Could ACA Market Stress Raise Costs for Self-Funded Employers?

The contrast between ACA premium rate hikes and the modest and predictable growth in self-funded plan costs might seem like good news for self-funded employers. Yet, stable numbers today don't guarantee smooth sailing ahead. The concern: ACA market stress could spill over into private commercial markets. This effect will likely unfold over time across multiple channels.  

Spiking ACA premiums could create rising uninsured populations in communities where self-funded employer members live and work. When more people lack coverage, providers shift the costs of uncompensated care elsewhere. That typically means higher negotiated rates across all commercial contracts. Industry analysts consulted by the AFL-CIO estimate that each of the 179 million people with job-based coverage could see their annual costs rise by $182 to $485.

How Self-Funded Employers Can Protect Their Plans From ACA Market Spillover

Our data shows that self-funded employers consistently outperform both ACA and fully insured plans on cost control. Employers who take charge of their data and dollars today are better positioned to manage their costs tomorrow. Spot early signs of spillover from ACA market stress (e.g. network contract disputes, rising administrative fees, or hidden spread pricing), verify actual costs, and proactively protect your plan from subsidized expenses they didn't create.

Don't wait for ACA market increases to spill into your plan. For ongoing analysis of healthcare market dynamics, subscribe to Trends in Spend and follow us on LinkedIn at Nomi Health.

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Want to know more? Check out how ACA premium stress impacts your employees.

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Frequently Asked Questions

How much are ACA premiums increasing in 2026?

‍ACA insurers are filing for some of the steepest increases in recent memory. Requested increases include 43% in Georgia, 41% in Florida, and 39% in Texas, well above the sub-10% increases that characterized the previous decade.

Are self-funded employers seeing the same cost increases as ACA plans?

‍No — not yet. Nomi Health analysis of 12 months of claims data from self-funded employers nationwide shows medical spend rose just 1.75% per member per month in 2023-2024, compared to ACA premium increase requests of 18-43% in the same states. In Florida, self-funded employer medical costs rose 0.35% while ACA carriers sought 41% increases.

Why are ACA premiums rising so much faster than self-funded employer costs?

‍ACA insurers cite rising patient utilization, worsening risk pools, and price inflation. Self-funded employers, who pay actual claims rather than pooled premiums, are insulated from these dynamics, but not permanently. ACA market stress can spill into commercial markets over time through provider cost-shifting and rising negotiated rates.

Could ACA premium increases eventually affect self-funded employer plans?

‍Yes, potentially. When ACA premium spikes create larger uninsured populations, providers shift the cost of uncompensated care to commercial contracts, including self-funded plans. Industry analysts estimate that each of the 179 million people with job-based coverage could see annual costs rise by $182 to $485 as a result.

What can self-funded employers do to protect their plans from ACA market spillover?

‍Self-funded employers should monitor for early warning signs including network contract disputes, rising administrative fees, and hidden spread pricing. Employers with access to their own claims data are better positioned to spot these trends early and respond proactively rather than absorbing costs reactively.

What is the difference between self-funded and fully insured health plans?

‍In a fully insured plan, an employer pays a fixed premium to an insurance carrier that assumes the financial risk of claims. In a self-funded plan, the employer pays claims directly and retains the financial risk but also gains access to their own claims data, greater plan design flexibility, and typically lower administrative costs. Nomi Health's analysis consistently shows self-funded employers outperforming fully insured plans on cost control.

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