Enhanced health insurance subsidies created under the Affordable Care Act have expired, leading to higher premiums for millions of Americans who purchase coverage through the federal marketplace. The subsidies, formally known as premium tax credits, were expanded during the COVID-19 pandemic to lower monthly insurance costs and extend eligibility to higher-income households. Those enhancements ended on Jan. 1, 2026, after Congress failed to pass legislation renewing them.
The expanded subsidies were first enacted under the Affordable Care Act through the American Rescue Plan Act and later extended by the Inflation Reduction Act. Together, those measures increased the size of subsidies and removed the income cap that previously limited who could qualify for assistance.
What Changed
Under the expanded rules, marketplace enrollees were protected by a cap that limited how much of their income they had to spend on premiums. Higher-income households that previously did not qualify for subsidies became eligible, and lower-income households received larger credits. With the expiration of those provisions, subsidy eligibility has reverted to pre-pandemic rules. Assistance is once again limited to households earning up to 400% of the federal poverty level, and subsidy amounts are smaller for those who still qualify.
Impact on Premiums
As a result, many enrollees are seeing sharp increases in monthly premiums in 2026. Analysts estimate that some consumers could see their costs double or more, depending on age, income and location. Middle-income households are among those most affected, as many no longer qualify for any financial assistance. Health policy experts warn the higher premiums could lead some individuals to drop coverage entirely, increasing the number of uninsured Americans and placing additional strain on hospitals and health systems.
Broader Implications
Older adults and people with chronic health conditions are considered particularly vulnerable to the changes, as they often face higher premiums and ongoing medical expenses. Consumer advocates also warn that rising costs may cause individuals to delay or forgo necessary care. Enrollment declines could also affect the stability of the individual insurance market by shrinking the risk pool, potentially driving premiums higher in future years.
Legislative Outlook
Lawmakers have discussed reviving or extending the enhanced subsidies, but no legislation has been enacted. Any future action would require congressional approval and presidential signature. Until then, the enhanced subsidies remain expired, and 2026 premiums reflect the rollback to earlier ACA rules.
