Choices made—or left unmade—during the next few months may determine the future of health insurance for millions of Americans over the next ten years.
The reason is that the “enhanced premium tax credits” (ePTCs), part of the Affordable Care Act (ACA), are scheduled to end on December 31. These ePTCs are additional subsidies introduced during the pandemic to help lower the cost of coverage. They directly cut the monthly premiums individuals pay for their marketplace health insurance.
Currently, the subsidies are available to individuals in the low- to middle-income bracket. For a single person, this typically falls between $15,000 and $60,000 annually. Those earning more than this — beginning around $62,600 — are not eligible for the same level of assistance, but they still gain from a regulation that caps their premiums at 8.5% of their income [1].
If the credits are not extended before the government funding deadline on September 30, the Congressional Budget Office (CBO) cautions that premiums might increase when open enrollment starts on November 1, because of uncertainty regarding the future of ePTCs [2]. It remains uncertain whether Republicans will follow Democrats’ request to extend ePTCs by the New Year’s Eve deadline.
If the tax credits expire, U.S. residents might experience sharply increased premiums, leading to 4.2 million people being without insurance by 2034, as per CBO projections [3]. The non-profit Urban Institute, on the other hand, estimates that 7.2 million Americans could lose their coverage [4]. This is what could occur with premium costs if the credits end, what lawmakers are stating, and what individuals can do to safeguard their health insurance if they are worried about losing it.
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How much could health insurance costs increase?
The Urban Institute predicts that should the subsidies end, individuals with lower incomes may experience a significant increase in their insurance costs. For instance, a person earning approximately $23,000 to $30,000 annually could witness their annual expenses increase from roughly $180 to $905. Those earning near the upper end of that range, between $30,000 and $37,000, might face premiums rising from about $503 to $1,076.
[AARP states that 92% of individuals aged 50 to 64 who enrolled in the health insurance marketplace would encounter increased costs if ePTCs [5] were not available.]
In the meantime, the Kaiser Family Foundation states that individuals making approximately $60,000 annually as a single person would still receive some financial assistance if the subsidies end—but their tax credits would decrease, resulting in significantly higher premiums. Those earning more than this amount would no longer qualify for the credits and would need to cover the entire cost of their coverage independently.
In another report, Democrats cautioned that modifications to Medicaid under the One Big Beautiful Bill might result in approximately 11 million more Americans losing health insurance, raising the total number of uninsured Americans to 16 million over the next ten years [6].
What are lawmakers commenting on?
The Democratic party has been sounding the alarm regarding the expansion of ePTCs as the September 30 government funding deadline approaches. In addition to preventing higher premiums, the CBO report highlighted that permanently extending ePTCs by September 30 could lead to nearly 4 million more Americans obtaining health insurance over the next ten years.
They note that eliminating parts of the 2025 budget reconciliation bill concerning the ACA during the same period might make health insurance available to another 2.9 million Americans by 2035.
However, Republicans are currently split on whether they will continue the ePTCs beyond this year. Some believe that allowing the credits to expire could harm their image as they approach the 2026 midterms [7], while the views of other GOP members vary from a “wait and see” stance until after September 30 [8] to outright opposition to extending the ePTCs [9].
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What to do if you can’t afford health insurance
For individuals concerned about increasing costs and the possibility of losing their health coverage, there are several actions you can undertake to help reduce the impact.
High-deductible plans combined with an HSA:High-deductible plans typically come with lower premiums, making them a suitable choice if you anticipate being in good health. Including an HSA as a way to set aside funds for potential out-of-pocket expenses related to the deductible can serve as a useful backup, and this can be arranged either with or without a company-sponsored plan.
Find a lower-tier plan:Less expensive health plans do not consistently provide the same level of coverage as those available through the ACA marketplace, yet Mizuho Americas financial group notes that lower-tier exchange or employer-based plans can assist in “reducing but not completely removing the impact” of lost ePTCs [10].
Save, save, save:Several individuals keep emergency savings set aside, and if you haven’t started one for medical costs yet, now is a suitable moment to begin. There are various choices available other than HSAs, such as high-interest savings accounts and FSAs — however, with the latter, you must spend the funds within the year or they will be forfeited. A financial advisor can assist in identifying the most appropriate savings account for your specific requirements.
Strategize:A financial advisor mentioned to CNBC that individuals whose income surpasses 400% of the FPL, and who obtained ACA tax credits in 2025, might “think about moving 2026 income to 2025, tax-loss selling, or taking a deduction for health savings account contributions” [11]. This is something worth discussing with a financial professional.
Preventative care:The better you take care of your health, the fewer costly medical visits and medications you will require. Maintain a nutritious diet, engage in regular physical activity, and schedule yearly checkups to reduce the likelihood of health problems becoming severe. This is an investment in both your well-being and your financial stability over time.
The future of these subsidies depends on two important dates: September 30, when Congress needs to decide if they will be extended, and December 31, when they are scheduled to end. Open enrollment starts on November 1, which means Americans may soon face higher prices even before the credits are exhausted. Whether legislators take action in time will influence what Americans pay for coverage in 2026—and how many families remain covered.
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[1]. IRSQualification for the Premium Tax Credit
[2]. CBOProjected Impacts of Implementing Certain Health Coverage Policies on the Federal Budget and the Population with Health Insurance
[3]. CBO. “E&C Reconciliation Recommendations”
[4]. The Urban InstituteHome Expenses for Premiums Would Increase if Improved Premium Tax Credits End
[5]. AARPPremium Tax Credits Help Maintain Affordable Health Coverage on the Marketplace for Adults Between 50 and 64 Years Old
[6]. CBOProjected Impact on the Number of Uninsured Individuals in 2034 Due to Policies Included in CBO’s Standard Forecast and H.R. 1, the One Big Beautiful Bill Act
[7]. PoliticoRepublicans consider prolonging ACA subsidies
[8]. The HillThune: Expired ACA subsidies will be ‘handled’ but not through temporary funding
[9]. CNBCAn expert warns that the ACA cliff could result in a ‘significant premium shock’ for 22 million people in 2026.
[10]. Mizuho AmericasWhat the expiration of ACA subsidies might imply for consumers and the economy
[11]. CNBCHealth plan participants on the ACA exchange might encounter a ‘subsidy drop’ in 2026 — here’s how to prevent it
This piece offers information solely and should not be interpreted as guidance. It is offered without any form of guarantee.
