Clark Howard Says Rising Hospital Market Power Is Helping Drive Bigger Health Insurance Premium Increases for Americans During 2026 Open Enrollment
WASHINGTON, DC — Health insurance renewal notices are landing as open enrollment approaches, and consumer money expert Clark Howard is warning that many families could face steep price increases in 2026. On his podcast, Howard said some people may see premiums rise as much as 20% next year, depending on where they live and how healthy people in their area stay in the insurance pool.
He said the increases are not simply about an insurer raising rates at random. Instead, he pointed to two forces working together: healthier people dropping coverage when costs rise, and powerful hospital systems charging more in many metro areas. Those pressures, Howard argued, are showing up directly in what consumers pay each month.
Why premiums can rise faster in some states than others
Howard said the size of a premium jump can vary widely from one state to another. In places where more people begin leaving coverage, insurers are left with a sicker group of customers on average, which pushes claims costs higher for everyone who remains insured.
He described a second tier of increases in states where fewer people are dropping out of the market, saying those premiums may rise by around 10%. In his example, a plan that costs $600 a month would climb to $720 with a 20% increase, or to $660 with a 10% increase. That difference can mean hundreds or even thousands of dollars over a year.
The basic problem, Howard said, is that insurance pricing reflects who is still in the pool. As healthier people leave, the remaining group tends to need more care, which makes coverage more expensive for the next round of enrollees too.
How the insurance pool gets more expensive over time
Howard said the cycle can become self-reinforcing. When premiums rise, healthy consumers are often the first to decide that coverage is no longer worth the cost. That leaves behind people who are older, sicker, or more likely to use medical services, raising the average cost per enrollee.
Insurers then respond by charging more to cover those expected claims. That can trigger another wave of dropouts among lower-cost customers, which in turn makes the insurance pool even more expensive. Howard said this is one reason renewal notices can feel so painful from year to year.
The result is not just a higher bill for one family. It can reshape the entire local market, making it harder for insurers to spread risk evenly across a broad group of customers. Howard said that is part of why the system keeps pushing prices upward.
Howard points to hospital monopolies as a major cost driver
Howard said the bigger structural issue is the pricing power of hospital systems in many metropolitan areas. In his view, insurers are often forced to accept higher rates because consumers expect access to the region’s main hospital, trauma center, or children’s hospital.
He said that power can build over years as hospital systems merge with competitors and buy independent hospitals, physician practices, imaging centers, and urgent care clinics. Over time, one or two systems can end up controlling much of a city’s hospital capacity and specialist access.
Once that happens, Howard said, the hospital system can demand more when contracts come up for renewal. Insurers have limited leverage if a plan without those facilities would be difficult to sell.
The price of one scan can change dramatically by city
Howard used an MRI as an example of how local market concentration can affect medical bills. In a more competitive city, he said, an insurer might pay about $1,000 for the scan. In a market dominated by one large hospital system, the same MRI could cost $2,500.
The procedure is identical, but the price is not. Howard said the higher charge reflects who has control of the local market, not a different machine or a different medical need. Those added costs eventually flow into premiums because insurers build expected claims into their pricing.
He also said hospital-owned doctor’s offices can add facility fees, which makes a routine appointment more expensive even when the physician is the same. In his view, that is one reason consumers often see higher bills without understanding where the extra money went.
What shoppers can do before choosing a plan
Howard urged consumers not to let their plans roll over automatically. He said people should compare their renewal price with at least two other options, whether through a state marketplace or an employer benefits menu, because plans are repriced every year.
He also advised checking networks facility by facility, not just by insurer name. A cheaper plan may look attractive at first glance, but it may not include the hospital system, lab, imaging center, or specialist group a family actually wants to use.
Another step is to calculate total annual cost, not just the monthly premium. Howard said shoppers should multiply the premium by 12, then factor in the deductible and out-of-pocket maximum to get a clearer picture of what the plan could really cost.
Using outpatient facilities to cut down on extra charges
Howard said consumers may be able to limit some of their exposure by using independent outpatient facilities when possible. In-network imaging centers and labs that are not owned by large hospital systems often charge less than hospital-based locations.
He suggested asking whether a facility charges a separate fee before scheduling care. That fee can make a difference even when the medical service itself seems routine. For people making health plan decisions, the location of care can matter almost as much as the coverage details on the policy.
Howard said switching plans does not change the underlying prices hospitals set, but it can change how much of the bill the consumer is responsible for. For that reason, he said open enrollment is the time to focus on which facilities are covered and how the plan handles real-world medical use.