The 2026 Affordable Care Act (ACA) open enrollment period — which ran November 1, 2025 through January 15, 2026 — was shaped by two major forces: the largest average premium increase since 2018 and the expiration of enhanced premium tax credits that had made coverage dramatically more affordable since 2021.
How Much Did Premiums Increase?
According to KFF (the health policy nonprofit), insurers raised marketplace premiums by an average of 26% for 2026, citing rising healthcare costs and high prices for popular prescription drugs. This is the sharpest single-year increase since 2018. A plan that cost $400/month in 2025 could now cost roughly $504/month before any subsidies are applied.
What Happened to the Enhanced Subsidies?
The enhanced premium tax credits — first introduced during the COVID-19 pandemic in 2021 and extended through the Inflation Reduction Act — expired at the end of 2025. Those credits had capped monthly premiums at no more than 8.5% of household income, allowing roughly 4 out of 5 marketplace enrollees to find coverage for $10/month or less.
Health policy experts warn that the more than 5 million adults aged 50–64 who depend on ACA marketplace coverage are among the hardest hit, since they face the highest base premiums and can no longer rely on the expanded credits.
Enrollment Stayed Near Record Highs Despite Higher Costs
Despite the premium shock, CMS reported that 23.1 million Americans enrolled in ACA marketplace coverage for 2026 — down modestly from the record 23.6 million who enrolled for 2025, but still among the highest enrollment totals in the program's history. The resilience of enrollment suggests that for many Americans, marketplace coverage remains the best available option even at higher prices.
What You Can Do If Your Premium Increased Sharply
- Check your subsidy eligibility: Even without the enhanced credits, standard premium tax credits remain available if your income is below 400% of the federal poverty level (roughly $60,240 for a single person in 2026).
- Compare metal tiers: If you're healthy and rarely use care, a Bronze plan with a lower premium and higher deductible may save money overall.
- Look at catastrophic plans: If you're under 30 or qualify for a hardship exemption, catastrophic plans offer lower premiums.
- Consider an HSA-eligible plan: A High Deductible Health Plan paired with a Health Savings Account lets you pay premiums and medical costs with pre-tax dollars.
- Report life changes promptly: Marriage, divorce, a new child, or a change in income can trigger a Special Enrollment Period and updated subsidy amounts.
What to Watch for During 2026 Open Enrollment (November 2026)
Policy debates around the ACA are ongoing in Congress. Proposals to restore some version of the enhanced subsidies remain active, and any legislative changes could affect what you pay when 2027 open enrollment opens in November 2026. Keep an eye on official announcements from HealthCare.gov and your state's marketplace exchange.
Who Is Most Affected by the Subsidy Expiration
The expiration of enhanced premium tax credits affects different income groups very differently, and understanding where you fall helps clarify your options.
Under the enhanced subsidies that were in effect 2021–2025, the credits were available to households of all income levels who enrolled in marketplace coverage — there was no upper income cliff. Under the original ACA subsidy structure that has been restored for 2026, subsidies phase out at 400% of the federal poverty level (approximately $60,240 for a single person, $124,800 for a family of four).
The groups hit hardest by the expiration:
- Adults aged 50–64 with moderate incomes: This group faces both the highest base premiums (insurers can charge up to 3x more based on age) and the loss of enhanced subsidies that previously made their coverage affordable. For a 60-year-old earning $65,000 — just above the 400% FPL threshold — a benchmark silver plan that cost $150/month with enhanced subsidies might now cost $700–900/month.
- Self-employed individuals: Many small business owners and freelancers who don't have access to employer-sponsored coverage rely on the marketplace. The subsidy structure changes create substantial new costs for those in the 400–600% FPL income range.
- Early retirees: People who retire before Medicare eligibility at 65 are marketplace-dependent. Without enhanced subsidies, some face premiums consuming a substantial percentage of their fixed income.
Standard Subsidies Still Available: How They Work
Even with the enhanced credits gone, the original ACA premium tax credit remains available for households with income between 100% and 400% of the federal poverty level. The credit is calculated to limit the premium for a benchmark silver plan to a percentage of household income:
- Up to 133% FPL: capped at 0% of income (effectively free)
- 133–150% FPL: capped at 0–2% of income
- 200–250% FPL: capped at 6–8.5% of income
- 300–400% FPL: capped at 8.5% of income
- Above 400% FPL: no subsidy under current law
If your income is at or below these thresholds, substantial subsidies may still offset much of the premium increase. The key is accurate income estimation — if you overestimate your income, you'll receive less subsidy than you're entitled to and will reconcile at tax time. If you underestimate, you may owe subsidy repayment.
Silver Loading: A Strategy Worth Understanding
In states where insurers have built the cost of cost-sharing reduction (CSR) subsidies into silver plan premiums — a practice called silver loading — benchmark silver plan premiums are higher, which means subsidy amounts are higher. This can make bronze or gold plans cheaper than silver plans after applying the premium tax credit.
If your income falls between 100–250% FPL, you may also qualify for cost-sharing reductions that lower your deductible, copays, and out-of-pocket maximum — but only if you enroll in a silver plan. The interaction between CSR eligibility, silver loading, and your actual costs makes plan selection more complex than premium alone suggests.
Use our Health Insurance Calculator to compare total annual costs across metal tiers, and visit HealthCare.gov to see subsidy amounts specific to your household size and income.
Understanding the ACA Subsidy Cliff and How to Manage It
Under the original ACA subsidy structure restored for 2026, the "subsidy cliff" at 400% of the federal poverty level creates a sharp discontinuity: a household at 399% FPL receives subsidies; a household at 401% FPL receives nothing. For a single person, the 400% FPL threshold in 2026 is approximately $60,240.
This cliff has significant planning implications for people with variable income — self-employed individuals, freelancers, investors with capital gains, and early retirees with flexible withdrawal strategies. Income management strategies that were less critical with enhanced subsidies become important again:
- Roth conversion timing: Converting traditional IRA funds to Roth in a year when your income is below the subsidy cliff can make sense; converting in a year when it would push you above the cliff costs both the conversion taxes and the subsidy loss.
- Capital gains management: Harvesting capital gains in low-income years, below the subsidy cliff, minimizes both tax and subsidy impact. Bunching gains into a single year should account for subsidy implications.
- Self-employment income timing: Freelancers and self-employed individuals with flexibility in billing and income timing have some ability to manage the timing of their MAGI for subsidy eligibility purposes.
If your income is near the 400% FPL threshold, consulting with a tax advisor about income management strategies before the plan year begins can produce significant premium savings — potentially thousands of dollars annually in the current environment. Use our Health Insurance Calculator to estimate your net premium after subsidies across different income scenarios.