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ACA Marketplace Premium Payments: What To Do if Enhanced Credits Expire

The enhanced ACA premium tax credits are set to expire after 2025. Learn how to prepare for potential premium increases and stay covered.

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Since 2021, millions of Americans have enjoyed lower health insurance costs thanks to enhanced premium tax credits for Affordable Care Act (ACA) marketplace plans. These subsidies, expanded by the American Rescue Plan and later the Inflation Reduction Act, made coverage more affordable and accessible than ever. However, these enhanced credits are set to expire on December 31, 2025.

If Congress doesn't act to extend them, your health insurance premiums could increase significantly in 2026. This uncertainty can be stressful, but with proactive planning, you can navigate the change and maintain your coverage. This guide will walk you through the steps to take now to prepare for the potential end of enhanced ACA subsidies.

1. Understand the Financial Impact

The first step is to get a clear picture of how your premiums might change. The enhanced credits did two main things: they increased the amount of subsidy for people who were already eligible and expanded eligibility to people with incomes above 400% of the Federal Poverty Level (FPL).

Without an extension, the pre-2021 rules would return. This means many people will have to pay a higher percentage of their income toward their premium. According to the Kaiser Family Foundation (KFF), the average enrollee could see their premium payments more than double. source

What to do:

Use the Official Estimator: During the open enrollment period, use the estimator tool on HealthCare.gov or your state's marketplace website. As you enter your projected 2026 income, it will show you plan prices with and without the enhanced subsidies, giving you a personalized estimate of the potential increase.
Don't Panic: The numbers might be jarring, but they represent a worst-case scenario. Seeing them early gives you time to plan.

2. Re-Evaluate Your Plan Tier

If your subsidy decreases, your first instinct might be to switch to a cheaper, lower-tier plan like a Bronze plan. This can be a valid strategy, but it requires careful consideration. A lower premium often means higher out-of-pocket costs when you need care.

The ACA metal tiers are:

Bronze: Lowest monthly premium, highest costs when you need care.
Silver: Moderate premium, moderate costs. Crucially, you must be enrolled in a Silver plan to receive Cost-Sharing Reductions (CSRs) if you're eligible.
Gold: High monthly premium, low costs when you need care.
Platinum: Highest monthly premium, lowest costs when you need care.

Losing enhanced credits might paradoxically make a Gold plan a better financial choice than a Silver plan for some people, especially if they don't qualify for CSRs. You might pay more monthly, but a lower deductible and out-of-pocket maximum could save you thousands if you have a medical event.

3. Maximize All Available Financial Assistance

The enhanced premium tax credits are not the only form of financial help available.

Cost-Sharing Reductions (CSRs): These are "extra savings" that lower your deductibles, copayments, and out-of-pocket maximum. They are only available on Silver plans to individuals and families with incomes between 100% and 250% of the FPL. If your income falls in this range, a Silver plan is almost always the most cost-effective option.
State-Based Subsidies: Some states have their own subsidy programs that supplement the federal tax credits. Check your state's marketplace website to see if additional help is available.

4. Don't Go It Alone: Where to Find Help

Navigating health insurance is complex, especially when the rules change. You don't have to figure it all out by yourself. There are trained and certified professionals available to help you for free.

Who can help:

Navigators: Trained and certified individuals who can help you enroll in coverage, understand your options, and apply for financial assistance. They are required to be unbiased.
Certified Application Counselors (CACs): Similar to navigators, they are trained to help with the application and enrollment process.
Brokers and Agents: Licensed insurance professionals who can provide advice on plan selection. While they may receive commissions from insurers, they are a valuable resource for comparing a wide range of plans.

A knowledgeable expert can help you analyze your specific health needs and financial situation to find the absolute best plan for you. source

5. Smart Payment and Budgeting Strategies

Once you've chosen a plan, it's critical to stay on top of payments to avoid any lapse in coverage.

Set Up Autopay: The easiest way to ensure you never miss a payment is to automate it. You can set this up directly with your insurance carrier or through your marketplace account.
Budget for the New Amount: If your premium is increasing, adjust your monthly household budget immediately to account for the new expense.
Understand Grace Periods: If you receive a premium tax credit, federal rules provide a three-month grace period if you miss a payment. However, your insurer will only pay claims during the first month. If you can't pay the full amount owed by the end of the three months, your coverage will be terminated. It's a safety net, not a long-term solution.

Key Takeaways Checklist

Confirm the status of the enhanced subsidies. Check the news and HealthCare.gov for the latest updates as the deadline approaches.
Use the marketplace estimator to project your potential 2026 premium.
Review all metal tiers (Bronze, Silver, Gold, Platinum), not just the cheapest one.
Check your eligibility for Cost-Sharing Reductions (CSRs) if your income is below 250% of the FPL.
Schedule a free appointment with a navigator or broker to review your options.
Set up automatic payments for your chosen plan to ensure continuous coverage.

By taking these steps, you can reduce uncertainty and make the best decision for your health and financial well-being, no matter what happens in Congress.

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