What are projected out‑of‑pocket premium changes by income bracket if enhanced subsidies expire in 2026?
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Executive summary
If the enhanced premium tax credits (ePTCs) expire at the end of 2025, federal analyses and nonprofit researchers project substantial increases in out‑of‑pocket premium payments across income groups — on average more than doubling for subsidized enrollees and rising by hundreds to thousands of dollars depending on income and age [1] [2]. The burden will be concentrated among people under 400% of the federal poverty level (FPL) who now benefit most from the enhancements, but middle‑ and higher‑income families who briefly gained eligibility will also face steep increases or loss of aid [3] [4].
1. What “expiration” changes in the subsidy rules — and who it affects
The ePTCs temporarily capped benchmark plan premium contributions at lower percentages of income through 2025 and expanded eligibility above 400% FPL; those protections are scheduled to lapse Jan. 1, 2026 under current law, returning required contribution schedules and the old 400% cap unless Congress acts [5] [6]. That reversion means people between 100%–150% of FPL who can now get zero‑dollar premiums would again face a nonzero share of income, and many over 400% could lose subsidy eligibility entirely [5] [2].
2. How much payments would rise for lower‑ and moderate‑income enrollees
Analyses find the largest proportional jumps for lower‑ and moderate‑income enrollees: KFF estimates average subsidized enrollees would see annual premium payments rise by about $1,016 in 2026 absent an extension — a 114% increase from 2025 averages — and Urban Institute projects average net premiums for those below 250% FPL could rise from $169 to $919 in 2026 under standard PTCs [1] [3] [2]. Across incomes below 400% of FPL, KFF maps show out‑of‑pocket premiums would increase by “hundreds of dollars to over $1,500 per person on average,” reflecting the restored higher applicable percentages and updated IRS contribution caps [2] [6].
3. What happens to middle‑income and just‑above‑cap households
Middle‑income households that briefly benefited from the expansion — including many between roughly 300%–500% of FPL — face large dollar increases: Urban Institute finds net premiums for some above 400% would nearly double from $4,436 to $8,471 if they lose subsidies, while other analyses cite examples such as a 40‑year‑old earning $50,000 who could pay roughly $2,000 more in 2026 [3] [7]. The Bipartisan Policy Center highlights extreme cases for older couples near the former 400% threshold, where premiums could leap to many thousands or even tens of thousands of dollars annually without the enhancement [4].
4. Insurer filings and state variation — a more mixed picture on premium rate effects
Insurer rate filings and state circumstances complicate the headline numbers: some insurers expect modest additional gross premium increases of only 1%–7% because state policy, state‑level subsidies, or market dynamics can blunt or amplify effects, and some expect healthier enrollees to drop coverage raising average costs for remaining enrollees [8]. Analysts caution that insurer expectations are early and incomplete, and national estimates of out‑of‑pocket burden reflect both subsidy changes and projected shifts in the risk pool [8] [6].
5. Coverage and broader fiscal projections tied to premium changes
Empirical projections tie these premium hikes to coverage losses and fiscal tradeoffs: CBO and Joint Committee estimates show extending enhancements would expand coverage by millions over the coming decade, while non‑extension is projected to increase uninsurance by millions in 2026 and beyond — findings echoed by Urban Institute and CBPP analyses [5] [3] [9]. These studies also note that reversing the ePTCs could raise benchmark premiums and shrink enrollment, which then feeds back into higher net premiums for remaining enrollees [5] [3].
6. Limits of available reporting and what remains unresolved
The public reports provide clear ranges and illustrative examples but not a single, uniformly tabulated “by‑bracket” table that maps exact dollar or percent changes for every income band and demographic; estimates vary by age, location, family size, and insurer assumptions, and some state policies (e.g., Vermont, Oregon) will alter local impacts [8] [2]. Final, personalized out‑of‑pocket changes for any household therefore require the KFF calculator or similar tools using local 2026 premiums and individual income and family structure [10].