What will health insurance premiums look like after 2025 for low-income households?
Executive summary
If Congress does not extend the “enhanced” premium tax credits that expire at the end of 2025, available reporting and analyses show marketplace premiums and out‑of‑pocket premium payments will jump sharply in 2026 — KFF and The Atlantic cite an average premium increase of roughly 114% and the loss of coverage for millions; multiple analyses project between roughly 4 and 5 million people could become uninsured [1] [2] [3]. State and insurer filings reviewed by Commonwealth Fund and others show the largest percentage increases will hit lower‑income households and those near Medicaid eligibility thresholds [4] [5].
1. The cliff everyone’s preparing for: what expires and why it matters
Enhanced premium tax credits enacted in 2021 and extended through 2025 lowered the share of income many people pay for marketplace plans and temporarily expanded eligibility above 400% of the federal poverty level; those enhancements are set to expire December 31, 2025, and that expiration is the principal driver of the predicted 2026 premium shock [6] [7] [8].
2. How big the sticker shock could be — national averages and headline figures
Multiple policy groups and media outlets report large, rapid increases if enhancements lapse: KFF and The Atlantic cite an average premium jump of about 114% for affected enrollees and project millions more uninsured; Reuters and Newsweek cite analyses saying some premiums could more than double and that lower‑income households could see percentage increases far above the mean [2] [1] [9] [5].
3. Who would be hit hardest — lower‑income households and clinically vulnerable people
Commonwealth Fund’s review of insurer filings finds the steepest percentage increases for households earning roughly $23,000–$31,000 — a 400% rise in out‑of‑pocket premium spending from about $180 to $905 annually in their example — and other state reports warn that lower‑income households will face the largest percentage impacts [4] [5].
4. Enrollment and coverage consequences: fewer insured, sicker risk pools, higher base premiums
Analysts warn that higher net premiums will push healthier people out of marketplaces, leaving sicker, higher‑cost enrollees behind; insurers have already finalized 2026 rates assuming some healthier enrollees will exit, which could further raise underlying premiums for those who remain [10] [8] [4].
5. Numbers of people at risk — estimates vary but are large
The Urban Institute, Commonwealth Fund and other briefings cited in reporting project roughly 4–5 million people could lose coverage in 2026 if enhancements expire; the Congressional Budget Office and other modelers also project multi‑million increases in the uninsured population in alternative scenarios [7] [3] [1].
6. Geographic and demographic nuance: not every state or person will see the same change
State marketplaces report varying impacts — for example, Covered California saw enrollment declines tied to subsidy uncertainty and state-level analyses show different shares of enrollees who will experience premium increases; Black, Latino and lower‑income enrollment grew strongly under the enhancements, meaning communities of color may see disproportionate effects if supports disappear [10] [9].
7. Policy responses under discussion and competing agendas
Policymakers are debating fixes ranging from extending the existing enhanced credits to more market‑oriented alternatives that would deliver funds differently; partisan proposals include directing funds to consumers or expanding tax deductions, and political disagreements over how to replace the subsidies shape whether and how quickly Congress will act [6] [9].
8. What the reporting does not settle — limits of current projections
Available sources model different scenarios, use different baseline assumptions about insurer behavior, and sometimes extrapolate 2026 premiums from filings; projections of uninsured counts and percentage increases vary by methodology, and available sources do not provide a definitive single forecast for every income band or county [2] [4] [3].
9. Practical takeaways for low‑income households today
If enhancements are not renewed, low‑income households should expect substantially higher net premiums and possibly higher deductibles or narrower plan choices; analysts advise monitoring state marketplaces, checking Medicaid eligibility (some low‑income people may qualify for Medicaid in expansion states), and using subsidy calculators or state enrollment counsellors to estimate 2026 costs [11] [12] [8].
10. Bottom line — a policy decision with immediate consequences
The data and reporting converge on a clear conclusion: expiration of the enhanced tax credits at the end of 2025 will sharply increase premiums for millions, hit lower‑income households hardest, and likely raise the uninsured rate by millions unless Congress or states act to replace the subsidies [1] [2] [3].