What short-term steps can current Marketplace enrollees take now to prepare for higher premiums after 2025?
Executive summary
Prepare for sharply higher out‑of‑pocket premiums in 2026 if Congress lets enhanced premium tax credits (ePTCs) expire: multiple analyses find average enrollee premium payments would more than double (about +114%, from ~$888 in 2025 to ~$1,904 in 2026) and insurers have already priced 2026 assuming the credits end [1] [2] [3]. Insurers also cite rising medical costs and policy changes as drivers of insurer rate increases (median insurer rate requests of 7% in 2025 and higher, with some filings projecting double‑digit moves for 2026) [3] [4].
1. Understand the scale and the likely trigger
The main reason most Marketplace enrollees face big bill shocks is policy: the enhanced premium tax credits that slashed what enrollees actually pay are scheduled to expire at the end of 2025; KFF and others estimate average enrollee premium payments would rise roughly 114% if that happens [1] [2]. Separately, insurers’ 2026 filings include increases to reflect higher medical trend and the expectation that healthier people will leave the market if subsidies are cut — insurers say that added about four percentage points to their rate requests [3] [5].
2. Check your current subsidy status and projected exposure
About 92–93% of Marketplace enrollees received enhanced credits in 2025, meaning most people now benefit and would be exposed if ePTCs lapse; how much your bill changes depends on income, family size and location — middle‑income households and those above 400% of the poverty line face the largest jumps or outright loss of eligibility [6] [7]. State‑level and county differences are large; some rural areas are projected to see higher dollar increases than urban ones [8].
3. Short‑term consumer actions you can take now
a) Review your current plan and subsidy amount on your Marketplace account so you know your 2025 net premium (available sources do not mention step‑by‑step screenshots) [9]. b) During upcoming open enrollment shop every plan: if subsidies shrink, a lower‑premium bronze plan might cut monthly costs but raises out‑of‑pocket risk — cost‑sharing consequences are especially serious for people under 250% FPL who would lose cost‑sharing reductions if they downgrade from silver [9] [10]. c) Check whether you qualify for state‑level or other supplemental subsidies; some states cushion losses but analyses typically do not include state subsidies in national averages [1]. d) If you are near income thresholds, estimate how small income changes will affect eligibility — the so‑called “subsidy cliff” will return for incomes above 400% FPL if ePTCs expire [11] [6].
4. Financial preparations to ease the transition
Start budgeting for materially higher premiums: KFF’s example raises average payments by about $1,016 annually if ePTCs end [1]. Consider short‑term emergency savings for the first months of 2026, and evaluate whether employer coverage, COBRA, Medicaid eligibility (if income or family changes permit), or lower‑cost short‑term alternatives make sense in your case — open enrollment windows will be the critical time to switch coverage [12] [9]. Available sources do not discuss consumer borrowing or credit‑product strategies in detail.
5. Watch key dates, filings and legislative developments
Insurer rate filings and CMS guidance for plan year 2026 have already been posted and will affect choices during open enrollment (open enrollment for 2026 began Nov. 1, 2025 and runs through Jan. 15, 2026 on HealthCare.gov) [12]. Congress can still act to extend ePTCs; insurers have largely assumed the credits will lapse in their pricing, so any late legislative action could change net costs for enrollees but may not immediately change insurer filings [3] [1].
6. Competing viewpoints and policy context
Administration analyses and consumer advocates emphasize that rule changes and the expiration of subsidies will push premiums and out‑of‑pocket costs up and lead to coverage losses (CBPP and CMS summaries) [13] [9]. Insurers point to rising medical trend, new drugs (e.g., GLP‑1s) and enrollment composition as cost drivers in filings [3] [4]. Some summaries (CMS fact sheet) still project that many eligible re‑enrollees will have low after‑credit premiums in 2026 — showing variability across geographies and eligibility [12].
7. Limitations and what reporters are not saying
Available sources quantify average and median effects but stress large local and household variation; national averages (e.g., +114%) mask cases with much smaller or much larger dollar changes [1] [3]. Sources do not provide personalized calculators in this summary beyond referencing KFF’s tools and CMS projections — you should run your own household scenario on Healthcare.gov or KFF’s calculator during open enrollment [14] [12].
Bottom line: begin shopping and estimating now, build a small cushion for 2026 premiums, compare plan types carefully (premium vs. cost‑sharing tradeoffs), and monitor Congress and state subsidy programs because last‑minute policy moves would materially change what you owe [1] [12] [9].