Affordable Care Act in 2026: What the End of Enhanced Tax Credits Means for Families

Practical takeaway: As of January 1, 2026, the Affordable Care Act’s enhanced premium tax credits have expired. Many people who buy coverage through the ACA Marketplace are now paying significantly more each month, even if they keep the same plan. If you rely on marketplace coverage, it’s important to review your options and understand how the changes affect your budget and access to care.

What changed on January 1, 2026?

The enhanced premium tax credits, first expanded during the COVID-19 pandemic and later extended by Congress, expired at the end of 2025. News reporting from the Associated Press confirms that the enhanced credits ended “overnight,” leading to higher costs for millions of enrollees at the start of 2026 (AP News, January 2026).

Under the Affordable Care Act, premium tax credits limit how much people pay for marketplace coverage based on income. The enhanced credits temporarily:

Increased the size of subsidies for many households.
Removed the previous income cap at 400% of the federal poverty level.
Limited premium costs to no more than 8.5% of income for eligible enrollees.

With those enhancements gone, subsidies have reverted to their pre-pandemic structure.

How much could premiums rise?

Multiple recent analyses from KFF, a nonpartisan health policy research organization, estimate that average premium payments for subsidized ACA enrollees have more than doubled in 2026 for people who keep the same plan. One KFF analysis published in early 2026 estimates an average increase of 114% compared to 2025 for those who previously benefited from enhanced credits.

That average masks wide variation. In general:

Older adults (ages 50 to 64) may see some of the largest dollar increases because premiums are higher at older ages.
People just above 400% of the federal poverty level may lose eligibility for subsidies altogether.
Lower-income enrollees may still qualify for subsidies but could face higher out-of-pocket premiums than in recent years.

At the same time, the Centers for Medicare & Medicaid Services (CMS) reports that for eligible enrollees who still qualify for advance premium tax credits, some low-cost plans remain available, and the projected average premium after tax credits for the lowest-cost plan is about $50 per month in 2026 (CMS Plan Year 2026 Marketplace Plans and Prices Fact Sheet).

Other 2026 ACA rule changes to know

Beyond subsidy changes, CMS finalized updates in its 2025 Marketplace Integrity and Affordability Final Rule that affect how people enroll and stay covered in 2026. According to CMS, these changes include:

Adjustments to automatic reenrollment policies.
A requirement that some individuals who are automatically reenrolled in a $0 premium plan without confirming eligibility pay a small monthly premium.
Stricter reconciliation requirements for advance premium tax credits.

These changes are intended to reduce improper enrollments and limit repayment surprises at tax time, but they also add administrative steps that some consumers will need to navigate carefully (CMS, 2025 Marketplace Integrity and Affordability Final Rule).

Why coverage stability matters for health

Health insurance is not just about monthly premiums. Research consistently shows that stable coverage is associated with better access to care and, in some cases, better health outcomes.

For example, a large cohort study published in JAMA Network Open in December 2025 found that Medicaid expansion under the ACA was associated with lower mortality among patients with certain early-stage lung cancers. The authors noted that while causation cannot be definitively proven in an observational study, expanded and stable coverage was linked to improved survival over time.

That study focused on Medicaid expansion rather than marketplace subsidies. Still, it highlights a broader point: when coverage becomes less affordable or more unstable, some people delay care, skip medications, or miss preventive screenings. Over time, those disruptions can affect health, especially for people with chronic conditions, cancer, diabetes, heart disease, or mental health needs.

Who may be at higher risk in 2026?

Based on recent policy analyses and enrollment patterns, groups who may feel the impact most strongly include:

Adults ages 50 to 64 who are not yet eligible for Medicare.
Self-employed workers and small business owners who rely on marketplace coverage.
People with incomes just above subsidy cutoffs who now face the full, unsubsidized premium.
Rural residents in areas with fewer insurer choices.

Families should also consider how premium increases affect overall household finances. Higher insurance costs can compete with spending on food, housing, child care, or medications. In some cases, people may choose higher deductibles or narrower networks to keep monthly premiums lower.

What should marketplace enrollees do now?

If you buy coverage through the ACA Marketplace in 2026:

Log in and review your current plan. Premiums, deductibles, and networks may have changed.
Update your income information. Your tax credit is based on projected annual income. Errors can lead to repayment at tax time.
Compare plans, even if you like your current one. Another plan may now be more affordable after subsidies.
Ask for help if needed. Navigators and certified enrollment counselors can provide free assistance.

If you lose coverage or find it unaffordable, check whether you qualify for Medicaid in your state, especially if your income has changed. Medicaid eligibility rules vary by state, particularly in states that have or have not expanded Medicaid under the ACA.

What remains uncertain?

Health policy is dynamic. Congress could revisit subsidy levels in future legislation, and state-level policy decisions—such as reinsurance programs or state-based subsidies—may offset some premium increases in certain states.

Enrollment data over the next year will also clarify how many people drop coverage, switch plans, or transition to Medicaid or employer-sponsored insurance.

What this means for readers

The Affordable Care Act remains in place in 2026, and marketplace coverage is still available nationwide. However, the expiration of enhanced premium tax credits has changed the financial picture for many families.

If you or a loved one relies on ACA coverage, now is the time to review your plan, update your information, and understand your options. Insurance decisions affect not only your budget, but also your access to preventive care, medications, mental health services, and dental and oral health services that may be tied to overall wellbeing.

Staying informed—and checking your coverage details early—can help you avoid gaps in care and unexpected costs.

This article is for general informational purposes only and is not medical advice. Research findings can be early, limited, or subject to change as new evidence emerges. For personal guidance, diagnosis, or treatment, consult a licensed clinician. For current outbreak or public health guidance, follow your local health department, the CDC, or another relevant public health authority.

Sources

Centers for Medicare & Medicaid Services (CMS) – Plan Year 2026 Marketplace Plans and Prices Fact Sheet.
CMS – 2025 Marketplace Integrity and Affordability Final Rule.
KFF – Analyses of ACA enhanced premium tax credit expiration and 2026 premium impacts.
Associated Press – Reporting on expiration of enhanced ACA tax credits in January 2026.
JAMA Network Open (December 2025) – Study on Medicaid expansion and mortality in lung cancer.