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NJ health insurance costs soar for 2026

Open enrollment states under shadow of spikes

By: Scott Fallon
NorthJersey.com
USA Today Network - New Jersey

..... The warnings came more than a year ago.
..... Health care insurance was likely going to skyrocket in 2026, experts said.
..... Fast-forward to the open enrollment period for next year [2026] and the experts appear to have been right. Premium sand out-of-pocket costs are going up across the board - from employer-based plans to Affordable Care Act plans and Medicare.
..... A number of factors are contributing to the rising prices, including inflation, increased care costs, insurance company profits, an aging population needing more care and drug prices especially the enormous demand for weigh loss medications, whose prices were recently slashed by the Trump administration.
..... The biggest increase will be ACA plans used by half a million New Jerseyans who don't get insurance through an employer or the government - unless a last-minute deal is worked-out between Democrats and Republicans on Capital Hill. Public officials fear that the increases - an average of 175% - will prompt large numbers of New Jerseyans to forgo health insurance in 2026.
..... "Many actions taken by the federal government are having and will continue to have a negative impact on our residents; ability to afford health care," Governor Phil Murphy said when open enrollment began November 1. [2025]

Employer-based plans

..... Many of the 165 million Americans on employer-based plans are getting hit on two fronts.
..... Premiums on those plans are expected to rise by about 6% to 7% in 2026 - the highest increases in years, said the consulting firm Mercer.
..... The survey also found that 59% of employers will cut the cost of their 2026 plans by raising deductibles and out-of-pocket maximums, which will lead to higher costs for their employees when they receive care.

Affordable Care Act plans

..... Hopes that Congress would restore subsidies to keep down the cost of ACA premiums took a nosedive Sunday night November 9, [2025] when the Senate reached a deal to end the government shutdown without addressing the subsides.
..... Unless another deal is reached between Democrats and Republicans on Capitol Hill, those seeking ACA coverage will see a drastically sharp increase beginning January 1. [2026]
..... In New Jersey, the average premium increase for such plans - under GetCoverNJ.gov - would be more than $2,780 annually, or 175% due to the lack of tax credits as well as are incarcerates, according to estimates by the state Department of Banning and Insurance. About 466,000 of the 513,000 residents who are covered by the state's ACA marketplace would see an increase.

Medicare

..... Medicare - government insurance for seniors - is seeing one of its larges increase in recent years.
..... Premiums for Medicare Part B, which coves doctors' bills and other services, will rise about 12% to $206.50 from $185 this year [2025] - about twice as high as the increase from 2024 to 2025. The deductible goes to $288 form $257. The Part D deductible, which covers medications, will rise to $615 from $590.
..... Meanwhile, Social Security;s payments will rise by just 2.8% in 2026.
..... In New Jersey, insurance companies managing Medicare Advantage plans are pushing clients to HMO plans and away form PPO, outing restrictions on which doctors patients can see and requiring more referrals, said Robert Frank, who operates a Lodi-based company hat advises seniors on Medicare plans. That practice mirrors a national trend in which insurers are looking to better contain costs and maximize profits.
..... There have also been some widespread plan terminations. For instance, customers of Braven Medicare Choice who live in Bergen, Passaic, Middlesex, Camden and Hunterdon counties have been forced to find another plan. The company announced that it will no longer offer that PPO plan to residents of those counties in 2026.
..... "The pendulum needs to swing the other way, because it;s gone too far against the patients," Frank said.

..... Are you seeing a major increase in health care premiums and do you want to share your story? Reach out to reporter Scott Fallon at fallon@northjersy.com.

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