ACA Rule Changes Proposed by Trump Administration Could Raise Family Deductibles

Policy changes proposed by the Trump administration would alter Affordable Care Act (ACA) marketplace plans, resulting in higher deductibles and out-of-pocket costs for families in 2026.

The administration’s proposed rule would allow insurers to offer plans with lower actuarial values, which enables higher deductibles and reduces premium tax credits. These changes are part of a broader approach to modify the ACA marketplace structure and eligibility requirements for certain plan types.

Under the current ACA guidelines, catastrophic health plans for families have a deductible cap set at $21,200 for 2026. The proposed rule would raise the out-of-pocket maximum for catastrophic plans to $27,600 for families. Additionally, new marketplace plans could permit family deductibles as high as $31,000 in 2026.

The proposed changes also include expanded eligibility for catastrophic plans. In 2026, bronze and catastrophic plans would become Health Savings Account (HSA) eligible, regardless of whether they meet the IRS minimum deductible or out-of-pocket standards.

What the numbers show

• Family deductibles in some ACA plans could reach $31,000 in 2026
• Current cap for catastrophic plan deductibles is $21,200 for families
• Proposed out-of-pocket maximum for catastrophic plans is $27,600 for families
• Premium payments as a share of income could rise by 2.7 percentage points
• Between 750,000 and 1.8 million people could lose ACA coverage in 2026

The proposed rule would increase the share of income that individuals pay for premiums by 2.7 percentage points. Maximum out-of-pocket limits are projected to rise by approximately 4.3 to 4.5 percent in 2026. For a family of four with an annual income of $85,000, annual out-of-pocket costs could increase by about $900 under the new rule.

The Commonwealth Fund stated that the proposed regulations would allow insurers to offer plans with much higher deductibles, with some individual plans exceeding $15,000. The changes would also permit plans without defined provider networks, which could expose patients to balance billing and higher out-of-pocket expenses.

According to the Center on Budget and Policy Priorities, the proposed rule could result in between 750,000 and 1.8 million people losing ACA marketplace coverage in 2026. These estimates reflect the combined impact of higher deductibles, increased premium contributions, and reduced premium tax credits.

As these policy changes are considered, the ACA marketplace may see a shift in plan design and cost-sharing structures, with expanded eligibility for certain plan types and adjustments to maximum allowable deductibles and out-of-pocket limits.

* This article is based on publicly available information at the time of writing.