ACA Marketplace: Understanding the Upcoming Insurance Hikes

October 28, 2025

Imagine logging in to renew your health-insurance plan this November and discovering your monthly premium has nearly doubled — all because Congress couldn’t agree to fund the tax credits that have quietly kept your coverage affordable. That’s the stark reality for millions of Americans enrolled in the health insurance marketplaces under the Affordable Care Act (ACA).

Under the ACA, individuals and families who do not get health insurance from an employer or through a public program can shop at a federal or state-based “Marketplace.” Insurers offer plans in metal tiers (Bronze, Silver, Gold)—with varying premiums, deductibles, and out-of-pocket costs. What keeps many of these plans affordable is the federal premium tax credit. If you qualify (mainly based on income as a share of the federal poverty level), you receive a subsidy that reduces the monthly premium you pay.

Because of this subsidy, many enrollees pay only a modest portion of what might otherwise cost thousands of dollars. The Kaiser Family Foundation (KFF) found that thanks to the enhanced tax credits, an individual making $28,000 “will pay no more than around 1 % ($325) of their annual income towards a benchmark plan.” The system ties a person’s share of premium costs to their income, and the subsidy covers the rest. This critical safeguard has kept coverage within reach for millions of lower-income Americans.

Why Subsidies Are in Danger of Expiring

The wrinkle: the enhanced subsidies many people now rely on are temporary unless Congress renews them. These enhancements were introduced by the American Rescue Plan Act in 2021 and extended under the Inflation Reduction Act of 2022. They expanded eligibility (including households earning more than 400% of the poverty level) and reduced out-of-pocket costs for individuals. But unless renewed by year’s end, they sunset at the end of 2025.

Even more urgent: insurers are already filing their proposed 2026 premiums, assuming no renewal of the enhanced tax credits. KFF reported that enrollee net premium payments could increase by 114 % on average—from about $888 in 2025 to about $1,904 in 2026—if the enhanced credits expire.

What People with Low Income Will Face

For low- and moderate-income Americans who depend on the marketplaces, the expiration of enhanced subsidies is more than theoretical—it’s a budget-breaker.

If subsidies are eliminated, many enrollees will see their monthly premium contributions skyrocket. KFF’s analysis shows that without the enhanced tax credits, average annual premium payments for subsidized enrollees would more than double. Some households will lose eligibility altogether. For people earning above 400 % of the poverty level, that subsidy cliff means they go from some assistance to none. KFF explains that “people with incomes over four times the poverty level will no longer be eligible for any financial assistance” if the enhanced credits expire.

The rate increases compound the effect: insurers are proposing median premium hikes of around 18 % for 2026. Those who are already barely making ends meet may find the new premiums impossible. One enrollee in Florida told Health News Florida that she’s already struggling to cover other rising costs. “The rent is going up. The water bill is going up,” said the Florida resident. “I cannot afford a premium hike.”

A missing subsidy cushion means not just higher premiums but a greater risk of losing coverage altogether. As Jason Levitis, Senior Fellow at the Urban Institute, explained, “If you have fewer subsidies, you’re going to have less health coverage and less health care.”

Why Enrollment Has Grown Recently

Enrollment in the marketplaces has surged in recent years, and the subsidy enhancements are a significant reason. Before the enhancement period, around 11 million people used the marketplace; now more than 24 million are enrolled.

Several factors have driven the growth. The enhanced tax credits increased eligibility and lowered what many paid, making coverage far more accessible. Improved outreach and usability—especially as state-based marketplaces matured—helped consumers find and keep plans more easily. At the same time, rising costs in employer-based coverage pushed more people to shop for plans individually. According to KFF, the enhancements cut annual premium payments by an estimated 44 % (about $705) for many subsidized enrollees. “The enhancements made it easier for millions of people to afford health coverage,” said Larry Levitt, Executive Vice President for Health Policy at KFF. “If they expire, we could see those gains wiped out almost overnight.”

In short, more help meant more people using the marketplace. The flip side is that less help could mean fewer people—and higher premiums for those who stay.

What’s at Stake

At the core of the current federal budget impasse (which led to the shutdown beginning October 1, 2025) is a fight over whether to extend the enhanced subsidies. Democrats insist that any funding deal must include the subsidy extension, arguing that letting them expire would cause a major affordability crisis. Republicans are pushing for reopening the government without tying the subsidy question directly to the budget deal, saying the issue should be negotiated separately.

From a consumer standpoint, the stakes are enormous. Without subsidy extensions, millions may lose assistance, face steep premium increases, or drop coverage altogether. KFF’s district-level data show that premiums would at least double in many parts of the country if the enhancements are not renewed. Rising premiums could also cause healthier enrollees to opt out, worsening the insurance risk pool and pushing rates even higher in subsequent years.

For families already squeezed by inflation and rising living costs, this would trigger an affordability crisis. “The cost of health insurance is never going to be low enough for a person who makes just above poverty to be able to afford it,” said Cynthia Cox, Director of KFF’s Program on the Affordable Care Act. “If you want that person to have health insurance, then there needs to be financial assistance.”

If Congress doesn’t act, many Americans will pay far more—or lose coverage altogether. As open enrollment begins, millions will face difficult choices about whether they can keep the coverage that has protected them for years, and whether Washington will act before the bills come due.

Insure You Know

Before you finalize your renewal or new plan selection, it may help to check out Insure You Know — a secure, central place where you can store and manage the critical information your family will need (insurance details, plan documents, contact numbers, and more). Taking a few minutes now to upload your coverage information ensures you’re ready for whatever changes lie ahead, and helps keep everything organized so you’re not scrambling when the numbers on your bill jump or the policy rules shift.