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Fact check: How much does the ACA cost with the subsidies and without the subsidies in 2026
Executive Summary
The cost of ACA Marketplace coverage in 2026 depends heavily on whether the enhanced premium tax credits are extended; analyses converge that premiums and out-of-pocket premium payments will rise substantially if those enhanced subsidies expire, with different studies giving ranges from roughly a doubling of costs for many subsidized enrollees to much larger spikes for specific older or near-retirement households [1] [2] [3]. Policymakers and analysts project average premium rate increases in the mid-20s percentage range on the exchanges even before subsidy changes, but the withdrawal of enhanced credits would convert those list-price increases into far larger net cost increases for enrollees who currently receive credits [4] [5] [6].
1. The central claim: Subsidy expiration would trigger sharp out-of-pocket spikes
Multiple sources state the same core claim: if enhanced premium tax credits lapse, most subsidized Marketplace enrollees will face far higher annual premiums in 2026. The Urban Institute and related analyses estimate millions could lose coverage or face large premium bills, with one study quantifying an average savings of $1,016 in 2026 if enhanced credits are extended (implying equivalent cost increases if they expire) and projecting 4.8 million people losing coverage under expiration scenarios [1] [7]. News outlets cite sharp percent changes — for example, reporting that subsidized enrollees’ out-of-pocket premium payments could more than double or rise by roughly 75–114% in many cases — illustrating consistent modeling across think tanks and press analyses that policy status of credits is the decisive factor [2] [5] [3].
2. How big are the headline average price changes versus net costs to consumers?
Headline marketplace premium rate changes and net consumer costs diverge in the coverage debate. Analysts report average list-price premium increases around 18–26% for 2026, reflecting insurers’ filings and market conditions [5] [4]. But nearly all enrollees (about 93%) currently receive premium tax credits, so the practical consumer impact depends on whether those credits continue; without them, net out-of-pocket premiums for many would escalate far more than the headline 18–26% increase, because credits currently absorb a large share of list-price growth [8] [6]. Thus the policy question is not just insurer pricing but whether Congress/administration actions preserve the affordability shield for enrollees.
3. Concrete household examples showing asymmetric impacts by age and income
Reporting and modeling supply concrete examples showing asymmetric impacts: older enrollees and middle-income families are especially vulnerable. A commonly cited case is a 60-year-old couple earning $85,000 projected to face annual premium increases exceeding $22,600 without enhanced credits — a reflection of age-rated list prices combined with loss of subsidy protections [2] [3]. A family of four earning $70,000 is also modeled to face several thousand dollars more per year if credits lapse [8]. These examples underscore how identical percentage changes in list prices translate to much larger dollar shocks for older or higher-income households who currently receive reduced but still meaningful credits.
4. Coverage and market stability consequences beyond premiums
Analysts warn that subsidy expiration would do more than raise premiums: it would shrink enrollment and destabilize risk pools, raising premiums further. The Urban Institute projects millions losing coverage if enhanced credits expire, and tracker analyses expect healthier enrollees to be more likely to drop coverage, thereby worsening average risk and pushing insurers to request higher rates [7] [5]. News coverage reflects this dynamic, noting that both insurer rate filings and consumer behavior interact — insurers price based on expected enrollment and claims, and large subsidy-induced churn or exit would feed back into higher list prices and fewer plan options in some states [6] [4].
5. What the different sources agree on and where they diverge
All cited sources agree on the broad conclusion that losing the enhanced premium tax credits would materially increase net premiums for many Marketplace enrollees in 2026 and risk higher uninsurance and market disruption [1] [7] [3]. They diverge on magnitudes and framing: some emphasize average percent changes in headline premiums (18–26%) drawn from insurer filings and marketwide averages [5] [4], while others focus on percent or dollar increases in out-of-pocket burdens for subsidized households (75–114% or thousands of dollars for particular families) to highlight distributional consequences [2] [3]. The studies and reporting consistently date to late 2025 and early fall 2025, reflecting the most recent modeling and insurer filings available at the start of 2026 Open Enrollment [1] [8] [6].