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With the government shutdown expected to end soon, lawmakers are expected to take up a bill in December to extend the enhanced advance premium tax credits. Most observers see any such bill as dead on arrival. And if Congress fails to pass a bill before the end of the year, millions of Americans could see their Affordable Care Act premiums soar beginning Jan. 1, 2025. The enhanced subsidies, first enacted under the American Rescue Plan and later extended through the Inflation Reduction Act, have helped keep premiums affordable for middle-income households. Without them, experts warn, coverage could again become unaffordable for millions. “Among subsidized enrollees living in states that use HealthCare.gov, premium payments would have been an average of 93% higher in 2024 without the enhanced tax credits” according to KFF. The Congressional Budget Office, as cited by KFF, projects that allowing the subsidies to lapse would result in about 3.8 million more uninsured Americans each year. Premiums could more than double for many families A KFF analysis shows how steep the increases could be. On average, annual out-of-pocket premium payments for ACA Marketplace enrollees will rise from $888 to $1,904, according to KFF. In addition, KFF revealed in its Sept. 30, 2025 report, “ACA Marketplace Premium Payments Would More Than Double on Average Next Year if Enhanced Premium Tax Credits Expire”) just how steep those increases could be: A family of four earning $75,000 would see annual premiums for a benchmark Silver plan rise from $2,498 under current subsidies to $5,865 in 2026 – an increase of $3,368. A family earning $90,000 would see costs climb from $4,680 to $8,415 – an increase of $3,735. A family earning $130,000 (about 404% of the federal poverty level) would lose all premium assistance and pay the full cost of coverage. For individuals, a 35-year-old earning $35,000 would see annual premiums rise from $1,033 to $2,615 – up $1,582 a year. Someone earning $55,000 would see costs increase from $4,010 to $5,478 – a $1,469 jump. Hardest-hit regions: The South The KFF Congressional District Interactive Map indicates that Southern states would likely experience some of the most significant effects. In Alabama’s 5th Congressional District, which includes Lawrence, Limestone, Madison, Morgan, Jackson, and part of Lauderdale counties, a 60-year-old couple earning $82,000 would see monthly premiums rise from $581 to $2,423 if the subsidies expire. The district has about 52,000 Marketplace enrollees – roughly 7% of the population. More Health Care: Watchdog group warns Costco members on key health threat How AI Could Monitor Brain Health and Find Dementia Sooner ACA Enrollment 2026: What You Need to Know Before Choosing a Health Plan In Mississippi’s 2nd Congressional District, which spans much of the state’s western region, about 83,000 residents – roughly 12% of the population – rely on ACA coverage, and nearly all receive advance premium tax credits. For a 40-year-old earning $31,000, the monthly premium for a Silver plan would jump 165%, from $58 to $153. A 60-year-old couple earning $82,000 would face a 252% increase, from $581 to $2,046 per month. Across all subsidized enrollees, average monthly premiums would rise 218%. For a detailed look at how premium increases could affect every congressional district, visit KFF’s interactive tool and premium calculator here. Millions could lose health coverage KFF estimates that average Marketplace premiums would more than double if Congress allows the enhanced subsidies to expire—a shift that would erase much of the affordability progress made since 2021. During that period, enrollment in ACA Marketplace plans has grown from about 11 million to more than 24 million, with most enrollees receiving some level of premium assistance. As KFF put it, “If the enhanced subsidies expire, premium payments would more than double on average for subsidized enrollees, effectively reversing the affordability gains achieved under the American Rescue Plan and the Inflation Reduction Act. Many consumers could face significant premium increases when they go to renew their coverage.” If the enhanced credits expire: 22 million people are at risk of significant premium hikes. Nearly 5 million could become uninsured in 2026 alone. By 2034, the number of uninsured could rise by 4.2 million. Those above 400% of the FPL would lose all subsidies. Who is most vulnerable Those most exposed include gig workers, self-employed individuals, part-time employees, and residents of states that have not expanded Medicaid. Rural consumers are also expected to be hit hardest. In many low-population areas, plans already cost more, so the loss of federal assistance could make coverage prohibitively expensive. According to KFF, “While some state-based Marketplaces offer additional premium financial assistance, the amount and availability of these state subsidies would not be enough to fully replace the federal enhanced subsidies.” Advisers offer practical strategies Financial advisers say those approaching 2026 should begin planning now to soften the potential blow. Jeremy Keil, a certified financial planner with Keil Financial Partners, said he’s advising his “retired, under-65 clients who are on ACA plans to do Roth conversions or extra withdrawals in 2025 so the income shows up this year – then live off the Roth or bank money in 2026,” That way, he said, they can aim to keep 2026 income low enough to still qualify for subsidies. For his part, Clark Randall, a certified financial planner with Creekmur Wealth Advisors, said: “This is truly a tragic situation, leaving millions in a quandary. If premiums spike, consider raising your deductible and eliminating office-visit copays to reduce costs.” He recommended using insurance for large medical expenses, not routine care. “But whatever you do, don’t drop coverage altogether,” said Randall. “It’s better to have a lower-cost plan that protects against catastrophic bills than to go uninsured.” Advisers agree that those likely to lose subsidies should revisit their income management, plan metal tier, and deductible choices before open enrollment begins next fall. Expert perspective: ‘The financial difference is thousands’ Jae Oh, author of Maximize Your Medicare and a nationally recognized expert on health insurance, said this year’s coverage choices may be the most complicated since the ACA’s launch. “It’s very complicated this year,” Oh wrote on his Substack account. “We may need multiple plans of action for every person. The financial difference is thousands – this should be obvious to everyone.” He urged consumers not to treat ACA plan selection as routine. “I promise this will be news to someone you know,” he said. “People underestimate how big the dollar impact can be.” Oh also cautioned that many Americans still misunderstand what the ACA actually does – and that confusion can cloud judgment. “Cancer doesn’t care what your politics are,” Oh said. “Before the ACA, many people couldn’t get health insurance at any price, or would have gone bankrupt paying for it. That’s the world we’re still working to fix.”
