ACA premiums to surge in 2026. Here’s what to do about it

Core Insights - Millions of Americans purchasing health insurance through the Affordable Care Act (ACA) marketplace are facing significant premium increases in 2026 if enhanced subsidies expire on December 31, leaving many in uncertainty due to stalled congressional negotiations [1][6] Group 1: Subsidy Impact - The return of the "subsidy cliff" will result in individuals earning over 400% of the federal poverty level losing all federal assistance, which translates to full premium payments regardless of the cost [2] - ACA subsidies currently assist 22 million out of 24 million marketplace enrollees, with approximately 1.8 million enrollees earning between 300% to 400% of the federal poverty limit and another 725,000 earning between 400% and 500% [2] Group 2: Premium Increases - Current enrollees receiving subsidies could see their average monthly premium payments more than double, with an estimated increase of about 114% if premium tax credits are not extended [3] - Premiums for older adults aged 50 to 64 can be up to three times higher than those for younger adults, indicating a significant disparity in costs [3] Group 3: Income Calculation - The ACA evaluates enrollees' modified adjusted gross income (MAGI) rather than adjusted gross income (AGI), which can lead to confusion among participants [4] - MAGI includes certain deductions added back to AGI, potentially pushing earners closer to or over the 400% threshold, exemplified by a 60-year-old earning $64,000 facing premiums of $14,931 without subsidies compared to $6,175 with federal assistance, highlighting a substantial cost difference [5] Group 4: Political and Economic Implications - The potential removal of subsidies poses a significant political challenge, as making insurance unaffordable could undermine the market and increase premiums for all [7] - California's premium prices are approximately 20% higher due to insurers anticipating fewer purchases if premium tax credits are eliminated, illustrating the broader market impact of subsidy changes [7]