Fact check: What are the projected cost increases for Medicaid and Medicare recipients after the subsidies expire?

1. Marketplace Shock: Who Loses Coverage and Who Pays More?

The clearest, recent projection states that expiration of enhanced premium tax credits would cause nearly 4.8 million people to become uninsured in 2026 and sharply worsen affordability for Marketplace enrollees, especially those under 250% of the federal poverty level, whose average net premiums would be over four times larger under the standard credits versus enhanced credits ^[1]. This analysis focuses on marketplace mechanics and premium subsidies rather than direct impacts on Medicaid or Medicare benefits, but the ripple effects include greater uncompensated care pressures on hospitals and potential state budget responses that could indirectly affect Medicaid eligibility or benefits in some states. The statement is time-framed to 2026 and is grounded in enrollment and premium modeling rather than direct beneficiary cost-sharing projections for Medicaid or Medicare ^[1].

2. Medicare: Payment Rates, Access, and Indirect Cost Pressure

Separate analyses highlight downward pressure on Medicare provider payment updates and the possibility of access issues for beneficiaries if payments remain insufficient, which could translate into indirect costs or reduced access for Medicare enrollees ^[2]. These sources do not quantify a post-subsidy dollar increase in Medicare beneficiaries’ premiums, deductibles, or copays tied to marketplace subsidy changes; they instead project that alternative payment-update scenarios would alter Medicare expenditures and could require program adjustments that affect beneficiary cost-sharing over time. The Congressional Budget Office’s microsimulation and technical descriptions provide tools for estimating beneficiary cost-sharing under policy changes but do not offer a single post-expiration price tag for Medicare recipients in the materials provided ^{[2] [3]}.

3. Medicaid: Enrollment Shifts and State Budget Responses That Matter

None of the supplied documents present a direct, quantitative forecast of Medicaid beneficiaries’ out-of-pocket increases tied to the subsidies’ expiration; however, the projected rise in uninsured Marketplace enrollees and premium unaffordability could increase Medicaid enrollment demand, safety-net strain, and state fiscal stress, prompting states to consider eligibility changes, benefit limits, or provider payment adjustments that would indirectly affect Medicaid recipients’ access and potential costs. The marketplace analyses emphasize coverage loss among those currently using premium subsidies rather than Medicaid churn, yet historical precedent shows that coverage dislocations can shift caseloads between Marketplace and Medicaid and put budgetary stress on states that might trigger policy responses ^[1].

4. Modeling Gaps: Why a Direct Medicaid/Medicare Price Tag Is Missing

The available sources provide detailed marketplace impact projections and technical modeling for Medicare cost-sharing scenarios but stop short of producing a unified estimate of out-of-pocket increases for Medicaid and Medicare beneficiaries post-expiration. The JAMA-related material flagged potential out-of-pocket savings under specific Medicare Part D reforms but did not link those savings to subsidy expirations on the Marketplace, and the CBO working paper offers a modeling framework rather than a specific forecast of beneficiary-level cost changes. In short, the evidence base here can quantify marketplace premium changes convincingly but lacks direct, recent modeled estimates tying those changes to Medicaid or Medicare beneficiary cost increases ^{[4] [3]}.

5. Bottom Line and What Would Be Needed for a Precise Estimate

To produce a precise dollar estimate of cost increases for Medicaid and Medicare recipients tied to the subsidy expiration would require integrated modeling that combines marketplace enrollment shifts, state Medicaid budget responses, and Medicare payment-update scenarios; the current documents provide pieces of that puzzle—marketplace premium impacts and Medicare expenditure scenarios—but do not deliver a combined projection of beneficiary out-of-pocket increases. Policymakers or analysts would need to run microsimulation models that link the four-million-plus enrollment shock in the individual market to state-level Medicaid eligibility and budget decisions and to projected Medicare provider payment adjustments to estimate beneficiary-level cost changes with confidence ^{[1] [2] [3]}.