As the new year approaches, millions of Americans are facing a significant increase in health insurance costs under the Affordable Care Act, especially if expanded tax credits are not renewed. This issue played a key role in the recent 42-day government shutdown, which came to an end in November. Without an extension or resolution from Congress, premiums are set to rise. The Get the Facts Data team has summarized crucial information regarding these anticipated increases.
Premiums could rise by an average of 114%
Analysis indicates that, if the tax subsidies lapse, premiums could more than double. It is important to note that not only may the subsidies be eliminated, but premium rates across both marketplace plans and employer-sponsored insurance are expected to rise as well. For instance, a single-person household earning $25,000—over 1.5 times the federal poverty level—could see their estimated annual out-of-pocket costs skyrocket from roughly $100 to $1,168. Monthly payments might jump to less than $98, compared to the prior cost of less than $9.
There’s an interactive tool available that illustrates potential changes in the maximum out-of-pocket rates for benchmark plans based on household size and income. Data for these estimates were derived from the KFF maximum out-of-pocket rates and the 2025 federal poverty level information released by the U.S. Department of Health and Human Services.
This tool, however, is not designed to determine individual payment amounts; for those specifics, it’s best to consult Healthcare.gov and similar state marketplaces.
The impact may be greater for people closer to retirement age and those with higher incomes
The expiration of the expanded tax credits at the close of this year will raise out-of-pocket limits universally, with individuals making over four times the poverty level becoming ineligible for tax credits. Almost 6.7% of those enrolled in ACA plans have incomes exceeding this threshold—about 1.6 million people—thus losing their subsidy once it expires.
People nearing retirement, particularly aged 55 to 64, are likely to feel this most acutely. In March, KFF estimated that around half of those losing tax credits due to expiration are between 50 and 64 years old. Premiums for this age group, especially for those with incomes over 400% of the poverty level, will rise more sharply than for younger individuals. For example, consider a 30-year-old, a 45-year-old, and a 60-year-old earning $62,756 in a single-person household, representing 401% of the poverty level. Without tax credits, the 30-year-old’s monthly premium for a silver plan could increase by $110, while the 60-year-old might see a spike of $881.
24 million people are enrolled in plans under the Affordable Care Act
Currently, around 92% of the 24 million people enrolled in ACA marketplace plans receive some form of subsidy, making expanded tax credits essential for maintaining affordable healthcare costs. These credits help households mitigate their out-of-pocket expenses according to their size and income.
Thanks to the expansion of tax credits through the American Rescue Plan Act of 2021, enrollment has more than doubled from 2020 to 2025, effectively lifting the cap that previously barred many from receiving subsidies if their income exceeded four times the poverty level. The federal poverty level is pegged at $15,650 for a single-person household, which equates to $62,600 at the 400% income threshold.
ACA enrollment has more than tripled in six states since 2020
Over the last five years, a notable increase in enrollment has been seen across various states. Six states—Georgia, Louisiana, Mississippi, Tennessee, Texas, and West Virginia—have experienced more than a threefold increase in enrollment since 2020, while there are 14 states where enrollment has more than doubled. Interestingly, data shows that only three areas, including Washington, D.C., have seen a decline in enrollment.
Expired subsidies take effect January 1st
The anticipated premium increases will come into effect on January 1st, but there’s the possibility of a retroactive extension being passed in 2026. KFF warns that it’s a complicated situation that may become increasingly difficult over time. In the meantime, some members may choose to cancel their insurance. A KFF survey revealed that about one-quarter of enrollees indicated they would go without health coverage if their premiums doubled, while roughly one-third mentioned they would search for lower premium options.
