Author: Justin Lo

Justin Lo is a senior researcher for the Program on Patient and Consumer Protections and the Program on the ACA. In this role, he focuses on the impact of health policy on patients’ experience with health care and marketplace insurance. Prior to joining KFF, he worked at Epic Systems, where he supported health systems in achieving their population health management objectives and conducted clinical epidemiologic studies using electronic health records.

Where ACA Premiums Could Spike Most in 2026 if Congress Lets Enhanced Tax Credits Expire

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The Affordable Care Act (ACA) offers premium tax credits to help make health insurance more affordable. Under original Affordable Care Act provisions, an income cap for premium tax credits was set at 400 percent of the federal poverty level. Above that threshold, federal financial assistance was not available, creating a “subsidy cliff.”

Enhanced premium tax credits expire at the end of this year. Enrollees currently receiving premium tax credits at any level of income will see their federal assistance decrease or disappear if enhanced premium tax credits expire, with an average increase of 114 percent to what enrollees pay in premiums net of tax credits.

The impact will be greatest for those whose unsubsidized premiums are highest: older Marketplace enrollees and those living in higher-premium locales.

Millions Face Sharp Increases in ACA Premiums if Enhanced Tax Credits Expire

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Affordable Care Act (ACA) enhanced premium tax credits—first introduced in 2021 and extended through 2025 by the Inflation Reduction Act—are set to expire at the end of this year. These tax credits have made Marketplace coverage far more affordable for millions of Americans, both by increasing financial assistance for low-income enrollees and by extending eligibility to many middle-income families for the first time. Since their introduction, enrollment in the ACA Marketplace has more than doubled—from about 11 million to over 24 million people.

If Congress allows the enhanced tax credits to expire, most Marketplace enrollees will face steep premium hikes. According to new analysis by KFF, the average enrollee’s annual premium payment would more than double—from $888 in 2025, to $1,904 in 2026. Some families would lose eligibility for any financial help at all.

A 60-year-old couple earning $85,000, for example, would see their premiums rise by over $22,600 next year—nearly a quarter of their income.

Without congressional action, millions could lose access to affordable coverage, threatening one of the ACA’s most significant achievements: making health insurance accessible to Americans across income levels.