A 60-year-old who buys her own health coverage on the Affordable Care Act marketplace is facing a bill that looks nothing like last year’s, and the cause has nothing to do with her health, her insurer, or her state. Congress let the law’s enhanced premium tax credits lapse on December 31, 2025, and the subsidy that used to cap her share of the cost at a fixed slice of income is simply gone. For someone earning $65,000 a year, the gap between subsidized and unsubsidized coverage now runs into five figures.
The $10,389 Gap in KFF’s 2026 Premium Numbers
A 60-year-old with an annual income of $65,000 — just over 415% of the federal poverty line — now pays $10,389 more per year, or $865 more per month, for the same coverage than she would have with the enhanced tax credits still in place, according to a KFF analysis of 2026 Marketplace premium data. The national average annual unsubsidized premium for a 60-year-old in 2026 runs $11,625 for the lowest-cost bronze plan, $15,914 for the benchmark silver plan, and $15,672 for the lowest-cost gold plan, per KFF’s analysis of ACA Marketplace premium data. Those figures are the full sticker price of coverage before any credit is applied — now the price many older enrollees are actually paying because their income puts them above the line where assistance still reaches.
The mechanics behind that jump go back to how the ACA’s subsidy formula was built. Since 2014, the law has capped what a subsidized enrollee pays toward a benchmark plan using a sliding scale tied to income, with a federal tax credit covering the difference. The enhanced version of that credit, added in 2021, extended assistance above 400% of poverty and deepened it further down the income scale. With the enhancement gone, anyone above that line is now on the hook for the full unsubsidized premium, with no credit cushioning the increase. Because unsubsidized silver plans are typically priced close to gold under a practice insurers call silver loading, most middle- and higher-income enrollees who lose their credit are left choosing between the leanest bronze option and a plan priced near the gold tier, with little affordable middle ground in between.
Free Medicare route finder: Help with Medicare costs runs through several separate programs, and each one uses a different form. Find the right one with the free route finder.
Why the 50-to-64 Age Group Is Absorbing Most of the Hit
Marketplace enrollees between 50 and 64 number close to 8 million people, about one-third of everyone who buys coverage through the ACA exchanges, based on KFF’s analysis of 2023 CMS enrollment data, the most recent year available. That concentration matters because Marketplace premiums are age-rated: insurers may charge older enrollees up to three times what they charge the youngest adults for an identical plan. While the enhanced credits covered the gap, that age penalty stayed mostly invisible to the people paying it. Without the credits, it becomes the deciding factor in whether coverage stays within reach. For an enrollee just above the 400% poverty line, the loss is not gradual — it removes every dollar of federal assistance at once, landing on top of a Marketplace where premiums were already climbing heading into the 2026 plan year.
Nationally, the average subsidized enrollee’s net premium payment is on pace to more than double this year, climbing 114% as the enhanced credits disappear, according to a separate KFF estimate of 2026 premium payments. Older enrollees carry a disproportionate share of that shift for a second reason: many buy Marketplace coverage because they have no other option. Nearly half of people in their early 60s with individually purchased insurance are still working, often in self-employment or at small businesses that don’t offer a group health plan, while roughly a third are already retired and waiting out the years until Medicare eligibility begins at 65. Employer-sponsored retiree health coverage for people not yet old enough for Medicare has grown increasingly rare, which leaves the Marketplace as the only realistic bridge for many of them.
Less Room Left to Trade a Premium for a Higher Deductible
One way enrollees can blunt a premium increase is to switch to a plan with a lower monthly cost and a higher deductible. That option is narrower than it used to be. Average deductibles in ACA Marketplace plans climbed to record highs for 2026, with the typical bronze plan now carrying a $7,476 deductible against $5,304 for a silver plan without cost-sharing help and $1,722 for gold, according to KFF’s deductible tracker for ACA Marketplace plans. An enrollee who downgrades from silver or gold to bronze to soften the monthly bill is trading a smaller premium for thousands more in out-of-pocket exposure before the plan starts paying for care. That climb didn’t happen in a single year — KFF’s tracker shows average deductibles rising across most years since 2014, with 2026 marking a new high point in all three metal tiers — so the households absorbing this year’s premium jump also have less of a cost-sharing cushion than enrollees had even a few plan years earlier.
That trade-off is especially tight for enrollees in their late 50s and early 60s who weren’t in a position to switch in the first place. Most people in that age group who don’t receive cost-sharing reductions were already sitting in a bronze plan, the cheapest tier available, heading into the 2026 plan year, leaving little room to cut costs further without dropping coverage altogether. KFF’s analysis, built from CMS’s 2023 enrollee-level data and the agency’s 2026 premium filings, presents the $10,389 figure as a national average: some enrollees, depending on income and location, are paying more, others less, but the underlying subsidy cliff reaches anyone over 400% of the poverty line who buys coverage on their own.
Medicare’s Own Cost-Sharing Maze After 65
For the roughly 8 million Marketplace enrollees between 50 and 64, today’s premium math is temporary in one sense: at 65, ACA coverage gives way to Medicare. Medicare doesn’t remove the cost puzzle, it changes its shape — Part B and Part D premiums, income-related surcharges, and plan-specific coverage rules replace the subsidy cliff described above. Prior-authorization denials and medication costs can strain a fixed income just as an unsubsidized Marketplace premium did before 65.
The Medicare Cost & Coverage Protection Kit is a 10-page kit covering the new Part D out-of-pocket cap and the prior-authorization appeal steps for enrollees who get a coverage denial.
Look up the 51 state Medicare cost-help packs and the medication and cost tracker inside The Medicare Cost & Coverage Protection Kit.
This article was researched and drafted with the assistance of AI and reviewed by an editor.
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.
