Which specific ACA premium tax credits expire in 2026 and who will lose them?
Executive summary
The temporary “enhanced” Affordable Care Act (ACA) premium tax credits created by the American Rescue Plan and later extended through 2025 are scheduled to lapse after December 31, 2025, returning subsidy rules to pre‑enhancement levels on January 1, 2026 (the enhanced PTC sunset date is January 1, 2026) [1]. If Congress does not act, analyses and trackers estimate millions would either lose eligibility or face far higher premiums — studies project roughly 4.8 million newly uninsured and millions more losing subsidies — and average marketplace net premiums would rise steeply [2] [3].
1. What exactly expires and when — the legal mechanics
The provision commonly called the “enhanced premium tax credits” refers to ARPA-era increases in subsidy amounts and the temporary elimination of the 400% federal poverty level (FPL) eligibility cap; those enhancements were extended through tax year 2025 by later reconciliation legislation and carry a sunset date that takes effect January 1, 2026 [1]. In practice, that means the higher subsidy amounts and expanded eligibility that lowered many enrollees’ required contributions will revert to the earlier ACA formula unless Congress extends or replaces them [1] [4].
2. Who specifically loses credits — the populations at risk
Millions of current marketplace enrollees will be affected, but harm is uneven: people with incomes above 400% FPL who became newly eligible under the enhancements will lose eligibility entirely; many enrollees under 400% FPL will receive smaller subsidies and pay substantially more; older enrollees and those in high‑premium states face the largest dollar and percentage increases [4] [5]. KFF and Bipartisan Policy Center analyses show middle‑income households (including 50–64‑year‑olds) and those in high‑cost states would see the steepest premium spikes [3] [5].
3. How big the coverage and cost impact looks right now
Recent estimates paint a dramatic picture: one analysis cited by Commonwealth Fund and Urban Institute projects about 4.8 million people could become uninsured in 2026 if the enhanced credits expire, and other studies project millions more would lose subsidized coverage [2] [6]. KFF models show average after‑subsidy premiums would more than double — rising 114% on average — and that many enrollees who paid little or nothing in 2025 would face substantial bills in 2026 [7] [3].
4. Why premiums themselves may also rise — insurer behavior
Insurers have signaled they expect the expiration to add to 2026 rate pressure. Early state filings in several marketplaces attributed roughly a 4 percentage‑point bump to anticipated subsidy expiration; KFF and other trackers note insurers are already proposing large rate increases for 2026, compounding higher out‑of‑pocket costs if the credits lapse [8] [3]. Analysts warn a sicker risk pool could remain if healthier enrollees drop coverage, pushing premiums higher still [9] [10].
5. Economic knock‑on effects and competing estimates
Beyond household bills, researchers predict broader effects: a Commonwealth Fund brief linked expiration to job and revenue losses and pointed to an Urban Institute projection of 4.8 million newly uninsured — figures used to estimate billions in lost provider revenue and increased uncompensated care demand in 2026 [2] [11]. Different groups model different magnitudes, but all sources agree the expiration would materially raise costs and reduce coverage for millions [2] [3] [6].
6. What policy options are on the table and the political context
Reports show lawmakers are debating short‑term extensions, longer reauthorization, or policy tradeoffs that pair subsidy extensions with other ACA changes; there is reported informal bipartisan conversation in the Senate but no settled deal, and advocates urge extensions while some Republicans press for structural changes [12]. Health policy analysts note marketplaces may need administrative adjustments (audits, consumer notices, extended open enrollment) to manage whatever transition occurs [12].
7. Limits of available reporting and open questions
Available sources provide detailed projections and insurer filings for parts of the country and model scenarios, but do not offer a single definitive nationwide tally of every household that will lose subsidies in 2026; exact outcomes hinge on Congressional action, state‑level insurer decisions, and enrollee behavior [8] [10]. Sources do not specify every affected individual by state and income bracket; granular impacts will depend on final 2026 premiums and any legislative fixes [7] [5].
Bottom line: the enhanced ACA premium tax credits cease to apply from January 1, 2026 unless Congress intervenes, and available analyses show that millions would lose eligibility or face much higher premiums — with older enrollees, middle‑income households, and people in high‑cost states most exposed [1] [3] [5].