The enhanced premium tax credits that lowered Affordable Care Act marketplace costs for millions of enrollees expired at the end of 2025, and Congress did not renew them before the change took effect this year. KFF now estimates that the average marketplace enrollee who receives a premium tax credit is paying 114 percent more out of pocket for 2026 coverage than in 2025. Adults between 50 and 64, who make up a large share of marketplace enrollment, are absorbing the sharpest increases as this fall’s open enrollment period approaches.
A Credit Congress Let Lapse
The enhanced tax credits were created in 2021 and extended through 2025, expanding marketplace help to middle-income households that had previously earned too much to qualify for any assistance at all. When Congress did not extend them again, the credits expired automatically, and no subsequent action has restored them for the 2026 plan year.
The dollar effect of that lapse is now measurable. The average marketplace enrollee receiving a subsidy paid $888 a year in both 2024 and 2025 while the enhanced credits were in place. Without them, KFF projects that average payment rising to $1,904 in 2026, an increase of $1,016, or 114 percent, for the same coverage.
The increase is sharper than earlier estimates for two compounding reasons. A federal rule finalized under the ACA Marketplace Integrity and Affordability regulation changed the formula used to calculate what enrollees above 400 percent of the poverty line must contribute toward a benchmark plan once the enhanced credits disappear, pushing that required share higher than under the prior methodology. At the same time, insurers proposed raising marketplace rates by a median of 18 percent for 2026, the largest increase since 2018, so the credits’ expiration is colliding with rising premiums rather than flat ones.
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Why the Increase Lands Hardest on Older Enrollees
People age 50 to 64 made up about a third of all marketplace enrollees, roughly 8 million people, in 2023, the most recent year with detailed enrollment data. That age group also accounts for about half of individual-market enrollees earning more than 400 percent of the federal poverty line, a threshold above which the enhanced credits had been the only source of marketplace assistance; without them, those enrollees now qualify for no subsidy at all. Marketplace premiums rise with age under federal rating rules, leaving unsubsidized premiums for older enrollees up to three times higher than for a 21-year-old buying the same plan, a combination KFF describes as a double whammy for middle- and upper-income enrollees in their late 50s and early 60s.
A 60-year-old earning $65,000 a year, or about 415 percent of the poverty line, is now paying $10,389 more annually, roughly $865 a month, than before the enhanced credits expired, to keep the same plan. With the credits in place, that enrollee spent about 8.5 percent of income on a silver or gold plan; without them, the same coverage now costs nearly a quarter of that income.
The Deductible Trade That Doesn't Erase the Cost
Some enrollees can dampen the premium increase by shifting to a plan with a lower monthly cost and a higher deductible, but that trade carries real costs of its own for 2026. The average deductible on a bronze plan is $7,476, compared with $5,304 for a silver plan without cost-sharing help and $1,722 for a gold plan. Most enrollees age 50 to 64 who don’t receive cost-sharing assistance were already enrolled in one of the cheapest plans available to them heading into 2026, leaving little room to shift to a lower premium without absorbing a much larger deductible. Those trade-offs are already shaping 2026 plan choices and will resurface again this fall, when enrollees return to the marketplace during the annual open enrollment period to select 2027 coverage under the same reduced level of assistance.
Why So Many Pre-Medicare Retirees Depend on the Marketplace
Marketplace enrollment climbs with age through the early 60s in part because fewer people that age have another source of coverage. Among people in their early 60s buying their own insurance, about a third were retired and a fifth were out of the workforce for disability or caregiving reasons, while the remainder were working, often in self-employment or small businesses that don’t come with a health plan. Employer-sponsored retiree coverage for people under 65 has also been shrinking: only 27 percent of large firms that offered health benefits in 2025 extended coverage to retirees younger than 65, leaving the marketplace as the only option for many who leave a job before Medicare eligibility begins at 65.
Many of those early retirees did not necessarily plan to leave the workforce when they did. A retirement confidence survey cited in KFF’s analysis found that most people who retire earlier than planned do so for reasons beyond their control, such as a health problem, a layoff, or a caregiving need, while a smaller share retire early because they feel they can afford to.
A Widening Gap Between States
The size of the increase also varies sharply by state. For a 60-year-old earning just above 400 percent of the poverty line and buying a benchmark silver plan, the annual premium payment increase runs to $22,452 in Wyoming, $22,006 in West Virginia, and $19,636 in Alaska, compared with $4,469 in New York, $4,728 in Massachusetts, and $4,877 in New Hampshire. In 19 states, that same enrollee’s premium payment more than triples, consuming over a quarter of their income. About nine in 10 marketplace enrollees have incomes below 400 percent of the poverty line and will keep some level of tax credit even without the enhanced version, though at a smaller amount than in 2025.
The Help When Premiums Climb
Separately, many of the same households facing higher marketplace premiums also qualify for programs that have nothing to do with the ACA credits. Medicare Savings Programs, Extra Help for prescription costs, and state drug-cost assistance programs exist specifically to lower what older adults pay for health coverage, but none of them enroll a person automatically. Because each requires its own application and no notice arrives when someone becomes eligible, many who qualify never file and the assistance goes unclaimed for years.
Across 69 pages it walks through the eleven programs, the 2026 income thresholds, and a directory of state phone numbers to call.
Look up each program’s 2026 limit and its state contact in The Benefits Checklist.
This article was reported and written with the assistance of AI and reviewed before publication.
David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
