As 2025 open enrollment approaches, individuals and families who rely on the Affordable Care Act (ACA) marketplace should be aware of a significant policy shift ahead. While coverage in 2025 will remain relatively stable, premiums are projected to increase substantially in 2026 due to the scheduled expiration of enhanced federal subsidies.

The temporary premium tax credits, which have helped reduce monthly insurance costs since 2021, are set to expire at the end of 2025. If no legislative extension occurs, millions of Americans may see their out-of-pocket insurance premiums increase sharply in 2026. This post outlines the changes expected in 2026, the implications for enrollees, and the steps individuals can take in 2025 to prepare for the coming shift.

2025 ACA Coverage: Stability for Now

For the 2025 plan year, ACA premiums are expected to increase modestly in most markets. Insurer filings generally reflect single-digit percentage increases, based on routine cost trends such as provider contracts, medical inflation, and utilization patterns.

Importantly, the enhanced premium tax credits that began in 2021, expanded as part of pandemic-era legislation and extended through the Inflation Reduction Act, will remain available throughout 2025. These subsidies continue to make plans more affordable for many individuals and families, including those who previously did not qualify for financial assistance.

As a result, most enrollees will still have access to cost-effective coverage for the upcoming year. However, these enhanced subsidies are scheduled to expire on December 31, 2025, which could lead to a very different pricing landscape in 2026.

Key Policy Change in 2026

Unless Congress passes new legislation, the enhanced subsidies currently lowering monthly premiums will end at the conclusion of 2025. At that point, subsidy eligibility and amounts will revert to pre-2021 formulas, which could reduce or eliminate financial assistance for many enrollees.

Analysts project that individuals who benefited most from the enhanced subsidies may see net premium increases of 70–75% in 2026. Those who received expanded tax credits due to moderate or middle incomes could face the most significant adjustments. Insurers are also anticipating that younger and healthier consumers may opt out of coverage when faced with higher premiums, leading to additional upward pressure on pricing due to a less balanced risk pool.

While future legislative action could potentially extend the subsidies again, no such extension has been enacted as of July 2025. Consumers are encouraged to plan based on the current expiration timeline and adjust if policies change.

Who May Be Most Affected

Not all enrollees will experience the same impact. Based on current projections, the following groups are most likely to see substantial changes:

• Individuals who recently enrolled due to subsidy expansion

• Middle-income earners who previously received little or no assistance

• Residents in high-enrollment growth states, including Florida, Texas, and Georgia

• Younger and healthier enrollees who are more price-sensitive and at higher risk of dropping coverage

In some cases, individuals in these groups may face difficult decisions about maintaining insurance or seeking alternative coverage options.

Steps to Take During 2025 Open Enrollment

Although the subsidy changes are expected in 2026, the choices you make during the 2025 open enrollment period will directly influence your healthcare costs in the year ahead. Below are four important actions to consider now to help minimize future surprises.

1. Review Your Subsidy Eligibility

Premium tax credits are based on your projected income, household size, and state of residence. With enhanced subsidies scheduled to end in December 2025, it’s essential to understand what your coverage might cost once those credits revert to pre-2021 levels.

What you can do:

• Log in to Healthcare.gov or your state’s health insurance exchange.

• Use the available subsidy calculator to determine how much assistance you currently receive—and what you might qualify for in 2026 if no new legislation is passed.

• If your income varies or you’re self-employed, consider estimating both higher and lower income ranges to see how changes could affect your premium.

• Households that saw a significant benefit from the expanded subsidies should pay close attention, as some may lose eligibility entirely under the original ACA formulas.

2. Compare Plan Options Carefully

Before you renew or select a plan for 2026, take the time to carefully compare coverage options. Premium costs are only one part of the equation. The deductible, copay structure, out-of-pocket maximums, and provider network can all have a significant impact on your actual costs throughout the year.

Also consider whether a plan qualifies as a high-deductible health plan (HDHP). These plans typically offer lower monthly premiums but require you to pay more upfront for services before coverage kicks in. They’re often favored by individuals who want to control premium costs while staying protected against major medical expenses.

HDHPs also unlock eligibility for a Health Savings Account (HSA)—a tax-advantaged savings tool that allows you to set aside money to pay for qualified healthcare expenses. If you're considering an HDHP for 2026, it's worth evaluating whether pairing it with an HSA could help you save in both the short and long term. These accounts can be especially helpful in offsetting future cost increases.

3. Plan for Future Costs

With premium increases projected for 2026, planning ahead now can make a real difference. Even if your 2026 rates haven’t been finalized yet, early estimates suggest that some individuals could see premium increases of 70% or more.

Steps to consider:

• Build a basic healthcare expense forecast using your current premium and a possible increase scenario for 2026.

• Revisit your household budget to identify areas where you could reallocate funds to prepare for higher insurance costs.

• If eligible, contribute to a Health Savings Account or other tax-advantaged savings vehicle to cover out-of-pocket expenses more effectively.

• Evaluate any recurring healthcare costs—like prescriptions or ongoing treatments—and factor those into your planning.

A proactive approach can help reduce the financial strain of unexpected changes and give you greater peace of mind when open enrollment begins.

4. Get Help from a Certified Professional

Health insurance decisions can be complex, especially when policies shift and financial assistance changes. Fortunately, help is available—and it’s free.

Certified enrollment professionals, including licensed insurance agents and ACA navigators, can walk you through your available options, compare plans, and help you understand your potential financial exposure in 2026.

You can find local help by visiting localhelp.healthcare.gov, where you can search for certified professionals in your area. These experts can assist in both English and Spanish, and many offer virtual appointments for added convenience.

Prepare Early, Stay Informed

While ACA plans will remain affordable for many individuals in 2025, the expiration of enhanced subsidies could lead to higher premium costs in 2026. Understanding these upcoming changes now can help you make more informed decisions during open enrollment.

Take time to compare plans, revisit your budget, and explore available resources to stay ahead of rising healthcare costs.

Why This Might Be the Right Time to Explore Lively

If you’re considering a high-deductible health plan, pairing it with a Health Savings Account (HSA) or Flexible Spending Account (FSA) can offer meaningful tax and budgeting advantages. Lively makes it easy to open and manage an account that fits your needs—with no hidden fees, intuitive tools, and expert support along the way.

As the healthcare landscape evolves, we’re here to help you stay prepared. Contact our team to learn more about how we can support your savings goals.