If you buy your health insurance through the ACA Marketplace, 2026 is the year the math changed. The “enhanced” premium tax credits that made coverage dramatically cheaper for millions of people — first passed in 2021 and extended through 2025 — expired on December 31, 2025. Congress did not extend them. For most Marketplace enrollees, that means a bigger bill in 2026, and for some, a hard decision about whether to stay covered at all.
This is not a small tweak. According to the nonpartisan Kaiser Family Foundation (KFF), the average subsidized enrollee’s out-of-pocket premium payment is set to more than double in 2026. Florida, which enrolls more people through the Marketplace than any other state, sits at the center of the change. This guide explains exactly what happened, how much more you may pay, who is affected most, and — importantly — what you can still do about it.
is the average increase in what subsidized ACA enrollees pay out of pocket for premiums in 2026 after the enhanced tax credits expired — the average annual payment rises from about $888 to roughly $1,904 (KFF).
Source: KFF, 2025–2026What the enhanced premium tax credits were
The Affordable Care Act has always offered premium tax credits (subsidies) to help people afford Marketplace coverage. In 2021, the American Rescue Plan Act temporarily made those credits much more generous — lowering the percentage of income anyone had to pay toward a benchmark plan, and, for the first time, extending help to people earning more than 400% of the Federal Poverty Level (the old “subsidy cliff”). The Inflation Reduction Act extended those enhancements through the end of 2025.
The effect was dramatic. Enrollment surged to record highs, and millions of people — including many in Florida — paid $0 or near-$0 premiums for a benchmark Silver plan. Marketplace enrollment roughly doubled nationwide during the enhanced-credit years. In our own guide to Florida ACA subsidies, we showed how a sample 45-year-old in Northeast Florida could qualify for roughly $480–$600 a month in help for 2026. Those figures reflect the standard ACA credits that remain — but the extra, enhanced layer on top is now gone.
How premium tax credits actually work
To understand what you lost, it helps to know how the credit is calculated. The ACA sets a “benchmark” — the second-lowest-cost Silver plan in your area — and says you should not have to pay more than a certain percentage of your household income toward that benchmark. The government covers the rest as a premium tax credit. Under the enhanced rules, those percentages were lowered across the board, and the hard 400%-of-poverty cutoff was removed so that no one paid more than 8.5% of income for the benchmark plan.
With the enhancements gone, the applicable percentages rise again and the 400% cliff returns. That has two consequences: everyone below the cliff gets a somewhat smaller credit, and people just above the cliff can lose their credit entirely — going from a subsidized premium to the full sticker price overnight. Because the credit is pegged to the benchmark plan, it also means that if benchmark premiums rise in your area (as they did for 2026), the math moves against you from both directions at once.
This is why two neighbors with similar incomes can see very different 2026 increases: it depends on their ages, their county’s benchmark premium, and exactly where their income falls relative to the poverty line. It’s also why a blanket “premiums are up X%” headline tells you very little about your own bill — the only way to know your number is to run it.
What actually changed on January 1, 2026
Two things happened at once, and it’s important to separate them:
- The enhanced credits expired. The bigger subsidies from 2021–2025 ended December 31, 2025. Standard ACA premium tax credits still exist, but they are smaller, and the 400%-of-poverty “cliff” has returned for many households.
- Underlying premiums went up too. Separately, insurers raised 2026 Marketplace premiums by about 26% on average nationally (before subsidies), citing medical costs and policy uncertainty, according to the Peterson-KFF Health System Tracker. In Florida, sticker increases have generally landed in the 8–15% range.
When you combine a smaller subsidy with a higher sticker price, the amount you actually pay each month can rise sharply — even if your plan and your health didn’t change at all.
How much more you’ll pay in 2026
The clearest way to see the change is the average premium payment. KFF estimates that subsidized enrollees’ average annual out-of-pocket premium rises from about $888 in 2025 to roughly $1,904 in 2026 — an increase of about $1,016 a year, or 114%.
Averages hide a lot of variation. Younger, lower-income enrollees who keep a low-cost plan may see a smaller dollar increase; older enrollees and those who lose eligibility above the income cliff can see much larger jumps. The point is that almost everyone pays more, and some pay a great deal more.
A real Florida example
To make it concrete: analysts have illustrated a 40-year-old in Miami-Dade County (which we serve — see our South Florida service area) earning about $22,590 a year. Under the enhanced credits in 2025, that person could pay $0 per month for a benchmark plan. In 2026, with the enhanced credits gone, the same plan could cost around $81 per month. That’s nearly $1,000 a year appearing on the budget of someone earning just above the poverty line.
The single most expensive mistake right now is assuming your 2026 price is the same as 2025 and letting your plan auto-renew without checking. Many people can lower the increase by switching plans or metal tiers — but only if they look.
Why Florida is hit especially hard
Florida has led the nation in Marketplace enrollment every year since 2015. For 2025, a record 4.7 million Floridians — more than one in five residents under 65 — were enrolled in Marketplace coverage. That is more people than any other state, by a wide margin. When subsidies shrink, a state with that many enrollees feels it more than anywhere else.
Floridians were enrolled in ACA Marketplace coverage for 2025 — #1 in the nation. That scale is exactly why the 2026 subsidy change lands harder in Florida than in any other state.
Source: CMS / HealthCare.gov, 2025It also matters that Florida did not expand Medicaid. That leaves more lower-income residents relying on the Marketplace rather than Medicaid, so the Marketplace subsidy change reaches deeper into working households here than in expansion states.
Our own service area shows the scale. Across the counties we cover, thousands of families rely on Marketplace coverage: Duval County (Jacksonville) alone has 142 plans available for 2026, and nearby Clay, St. Johns and Nassau counties each have their own local plan landscapes and subsidy levels. When the subsidy formula changes statewide, every one of those local markets feels it — which is why a county-by-county review matters. We break down the numbers for each on our locations pages.
Who is affected the most?
The pain is not evenly distributed. A few groups feel it most:
| Group | Why they’re hit |
|---|---|
| Households above 400% FPL | The old “subsidy cliff” returns — many lose subsidies entirely |
| Older enrollees (50–64) | Higher base premiums mean a bigger dollar increase |
| Self-employed & small-business owners | They buy their own coverage and feel the full swing |
| Early retirees (under 65) | Not yet Medicare-eligible; rely on the Marketplace |
| Rural & single-insurer areas | Less competition can mean higher benchmark premiums |
One striking data point: enrollees with incomes above the subsidy cliff made up only about 7% of 2025 enrollment but nearly half — 48% — of the drop in plan selections from 2025 to 2026, according to Marketplace data. In plain terms, the people who lost subsidies entirely are the ones most likely to walk away from coverage.
The bigger picture: coverage losses
When coverage gets more expensive, some people drop it. Independent analyses from the Urban Institute and the Commonwealth Fund project that the end of enhanced credits could lead to roughly 7.3 million people losing ACA coverage in 2026, with about 4.8 million becoming uninsured. The Congressional Research Service and CBO have documented similar upward pressure on the uninsured rate.
people are projected to become uninsured in 2026 as a result of the enhanced-credit expiration — part of an estimated 7.3 million losing ACA Marketplace coverage nationally (Urban Institute / Commonwealth Fund).
Source: Commonwealth Fund / Urban Institute, 2025Being uninsured is expensive in its own right — one hospital stay can erase years of “saved” premiums. That’s why, before dropping coverage, it’s worth exhausting every option to keep it affordable.
The ripple effects beyond your premium
The subsidy change doesn’t stop at your monthly bill. When millions of people drop coverage, the effects spread through the whole health system. Hospitals, physicians and clinics are projected to lose more than $32 billion in revenue in 2026 as more patients arrive uninsured or delay care — pressure that tends to show up later as higher costs for everyone. Analysts have also linked the change to job losses in health care and related sectors. And when healthier people drop out of the insurance pool first, the people who remain tend to be sicker on average, which pushes future premiums up further — a dynamic insurers price in when they set next year’s rates.
None of that changes what you can control today. But it’s useful context: the “cheaper” choice of going uninsured is rarely cheaper for you or your community once the full picture is counted.
Will Congress bring the enhanced credits back?
It’s a fair question, and the honest answer is: no one knows. The enhanced credits were a temporary policy, extended once, that lapsed when the latest extension wasn’t passed. Lawmakers have floated competing approaches, and the issue remains politically active. It’s possible some form of additional help returns; it’s also possible it doesn’t. What you should not do is bet your family’s coverage on a policy change that may or may not happen. Plan around the rules as they are today, and if the rules improve later, we’ll help you take advantage of it at your next renewal.
Comparing your metal tiers in 2026
When money is tight, the metal tier you choose matters more than ever. Marketplace plans come in Bronze, Silver and Gold (plus Catastrophic for those who qualify). Bronze plans carry the lowest premiums but the highest deductibles and out-of-pocket maximums — a fit if you’re generally healthy and want to protect against a worst-case year. Gold plans cost more monthly but pay more when you use care, which can suit people with regular prescriptions or ongoing conditions. Silver sits in the middle and is often the best value if you qualify for cost-sharing reductions, which lower your deductible and copays but are only available on Silver plans.
With subsidies smaller in 2026, some people who were comfortable on a Silver plan may find a Bronze plan (perhaps paired with an HSA) keeps their premium manageable, while others discover that a different Silver plan actually protects them better. There’s no universal right answer — it depends on your health, your prescriptions and your budget. The mistake is auto-renewing without comparing, because your old plan’s value can shift year to year.
A special word for early retirees and the self-employed
Two groups feel this change acutely. Early retirees — people who’ve stopped working before 65 but aren’t yet eligible for Medicare — often rely entirely on the Marketplace to bridge the gap, and many were newly helped by the enhanced credits above the old income cliff. Self-employed people and small-business owners buy their own coverage and feel the full swing of any subsidy change. If you’re in either group, it’s worth a careful look at your income projection: because credits are tied to modified adjusted gross income, thoughtful planning around retirement account withdrawals or business income can sometimes change your eligibility. That’s a conversation worth having before Open Enrollment, not after.
What you can still do about it
This is the part that matters most, because you have real choices. Here is what we walk clients through:
- Re-shop every year. The plan that was cheapest in 2025 may not be in 2026. Switching carriers or plans can offset much of the increase.
- Confirm your exact 2026 credit. Standard premium tax credits still exist. Use the subsidy checker on our ACA / Marketplace page, then we verify the precise amount on HealthCare.gov.
- Reconsider your metal tier. If you lost subsidies, a Bronze plan with an HSA — or a different Silver — may fit your budget better than auto-renewing your old plan.
- Check your income estimate. Credits are tied to your projected income. A careful, accurate estimate can change your subsidy and prevent a tax-time surprise.
- Don’t go uninsured by default. If cost is the issue, talk to us before dropping coverage — there is almost always a better plan than “nothing.”
- Mind your enrollment window. Open Enrollment is the main window; a qualifying life event can open a Special Enrollment Period. See our Jacksonville Marketplace guide for how plan choice works locally.
You do not have to figure this out alone — and it costs you nothing to get help. As a local independent agency, we compare every plan available where you live and find the most affordable path to staying covered.
Timing: don’t miss your window
All of this only helps if you act inside the right window. Open Enrollment is the main annual period to pick or change a Marketplace plan for the coming year. Outside of it, you generally need a qualifying life event — losing other coverage, moving, marriage, a new baby, and similar changes — to open a Special Enrollment Period. If your 2026 renewal shocked you, don’t wait until the next Open Enrollment if you have a qualifying event now; and if you don’t, mark the dates so you’re ready to shop rather than auto-renew. The worst outcome is discovering a better, cheaper option a month after the window closed.
When you sit down with us, it helps to have a few things handy: a recent pay stub or income estimate for your household, a list of the doctors you want to keep, and the prescriptions you take. With those, we can show you real numbers — your exact 2026 credit and your net premium on each plan — in a single conversation.
The bottom line for 2026
The expiration of the enhanced premium tax credits is the biggest shift the ACA Marketplace has seen in years, and Florida — with more enrollees than any state — is at the center of it. Premiums are up, subsidies are smaller, and some households above the income cliff have lost help entirely. But “more expensive” is not the same as “unaffordable,” and it is certainly not a reason to go uninsured. Standard subsidies remain, plans can be switched, and the right choice for your household is often better than the auto-renewed default. The families who come out of this okay are the ones who look at their options with clear eyes — ideally with a local guide who does this every day.
Turn your renewal letter into a to-do list
If a 2026 renewal notice landed in your mailbox and made your stomach drop, the most useful thing you can do this week is turn that letter into a short checklist instead of filing it away. A renewal notice is not a bill you have to accept — it is a starting point, and almost every figure on it can still change if you act inside your enrollment window. Read it with a pen in hand and pull out the numbers that actually matter for your budget.
- Find your new net premium. That is what you pay each month after your premium tax credit is applied — not the sticker price. It is the number that hits your bank account.
- Note whether your credit changed. Compare the credit shown for 2026 with what you received in 2025. If it shrank or disappeared, that tells you how hard the enhanced-credit expiration hit your household.
- Check the new deductible and out-of-pocket maximum. Carriers can adjust plan design year to year, so the plan you renew into may not be the plan you had.
- Circle the deadline. Every notice lists the date by which you must act to change plans for the coming year. Miss it and you are generally locked in until the next window.
- Confirm you can log in. Make sure your HealthCare.gov account still works before you need it. A forgotten password on deadline day is a common, avoidable problem.
Once those five items are in front of you, you are no longer guessing. You know your real 2026 cost, whether your credit moved, and how long you have to do something about it. That is the foundation for every decision below.
Running your 2026 numbers: two budget scenarios
Because the enhanced credits expired on December 31, 2025, and because underlying premiums rose separately, it helps to stress-test your budget against more than one outcome before Open Enrollment rather than hoping for the best. You do not need a spreadsheet — just sketch two versions of your year and see which one your household could absorb. For many enrollees the honest answer lands between them, and that middle ground is exactly where re-shopping earns its keep.
| Scenario | What it looks like | How to prepare |
|---|---|---|
| Manageable case | You keep a standard premium tax credit and switch to a lower-cost plan, so your net premium rises modestly | Identify the lowest-cost plan that still covers your doctors and drugs, and confirm your credit on your ACA account |
| Harder case | You fall above the returning 400%-of-poverty cliff and lose your credit, paying closer to full sticker price | Build room in the budget now, look hard at a lower metal tier, and price coverage before you assume it is out of reach |
Recall the national picture for context, not as a prediction of your bill: KFF estimates the average subsidized enrollee’s out-of-pocket premium rises from about $888 to roughly $1,904 for the year. Your own figure depends on your age, your county’s benchmark, and where your income sits relative to the poverty line — which is why we run it plan by plan rather than trusting the average.
How to re-shop your plan if the price jumped
Re-shopping is the single highest-value move most people can make, and it is more than clicking "renew." The plan that was lowest-cost for you in 2025 may not be the lowest-cost option in 2026, because carriers change their prices and their networks independently of one another. Here is the order we walk clients through so nothing gets missed.
- Start from your net premium, not the headline rate. Sort plans by what you would actually pay after your 2026 credit, since that is the number that varies most between plans.
- Re-enter an accurate income estimate first. Your credit is pegged to projected income, so getting that right before you compare keeps the plan prices you see honest.
- Check each plan against your doctors and prescriptions. A cheaper premium is no bargain if your physician is out of network or your medication sits on a higher formulary tier.
- Compare across metal tiers, not just within one. A different Silver plan — or a Bronze plan — may beat an auto-renewal you never questioned.
- Look county by county if you moved or work elsewhere. Benchmark premiums and plan menus are local; Duval County alone has 142 plans for 2026, and neighboring counties differ.
- Then decide — but decide before the deadline. Switching plans is only possible inside your enrollment window.
You can run much of this yourself using the subsidy checker on our ACA / Marketplace page, and our Jacksonville Marketplace guide walks through how plan choice works locally. When you want the exact numbers verified before the deadline, you can bring your renewal notice to us and we will price your options side by side.
Levers to pull if the plan is no longer affordable
Suppose you have re-shopped and the price still feels out of reach. Metal tier is the obvious dial to turn, and it has its own place in this guide — but it is not the only one. Several less-obvious levers can bring a plan back within budget without leaving you exposed, and they are worth pulling in order before you ever consider going without coverage.
- Plan network type. HMO plans often carry lower premiums than PPOs in exchange for a tighter network and referral rules. If your care is routine and local, that trade can be worth real savings.
- Provider directory fit. Some of your out-of-network costs come from a single provider. Confirming which of your doctors are in-network on a cheaper plan can change the math more than you expect.
- Drug formulary placement. The same prescription can be a low copay on one plan and a costly tier on another. Matching the plan to your specific medications protects your real, total cost — not just the premium.
- Pairing a lower premium with an HSA. An HSA-eligible high-deductible plan can lower the monthly bill while giving you a tax-advantaged way to set aside money for the deductible you are taking on.
- Catastrophic coverage, if you qualify. For those who are eligible, a Catastrophic plan is a genuine ACA option worth pricing rather than dismissing.
The theme across all of these is the same: the goal is the lowest total cost of care you can live with, not merely the lowest premium. A plan that saves you money every month but strands you at the pharmacy or the specialist’s office has not actually saved you anything.
A note on short-term plans and other stopgaps
When premiums rise, it is tempting to reach for anything cheaper, and the market is full of products advertised as low-cost "health plans." Be careful here. Short-term medical plans, health-care sharing arrangements, and fixed-indemnity products are not ACA Marketplace coverage. They can look attractive on price precisely because they cover less — many can decline you or exclude a condition based on your health history, cap what they pay, or leave out benefits that Marketplace plans are required to include. Because they are not qualified coverage, buying one also does not open a Special Enrollment Period or entitle you to a premium tax credit.
None of that makes these products universally wrong, but it does make them the kind of decision to walk into with clear eyes rather than out of sticker shock. Before you trade comprehensive coverage for a cheaper monthly number, it is worth confirming what you would actually be giving up — especially the protections for pre-existing conditions that make Marketplace coverage valuable in the year you unexpectedly need it.
Questions we’re hearing as the credits end
As 2026 renewals go out, a handful of questions come up again and again. Here are the ones worth thinking through before you make any change.
Can I switch plans mid-year if I can’t afford mine? Usually only if you have a qualifying life event — losing other coverage, moving, marriage, a new baby, and similar changes — which opens a Special Enrollment Period. Outside of that, Open Enrollment is the window to make a change, so the practical answer for most people is to get it right during that window rather than counting on a mid-year fix.
What happens if my income ends up different from my estimate? Your premium tax credit is based on the income you project, and it is reconciled on your tax return. Estimate too low and you may owe some credit back; estimate too high and you may have left help on the table. That is why we spend time on an accurate, realistic income figure up front — it protects your budget now and prevents a surprise at tax time.
Is it even worth staying on the Marketplace if I lost my subsidy? Often, yes. Standard premium tax credits still exist for many households, plan prices vary widely, and Marketplace coverage carries protections — like guaranteed issue regardless of health — that cheaper alternatives do not. Even above the income cliff, comparing every plan available where you live frequently turns up a more affordable option than the renewal notice suggested. The only way to know is to look at your own numbers with someone who does this every day.
How we help
McDowell Business Resources is a licensed independent agency based in Jacksonville, serving families across Florida. We shop the entire Marketplace for you, calculate your exact 2026 premium tax credit, compare plans on your doctors, drugs and budget, and enroll you — at no cost. If your 2026 renewal notice made your stomach drop, that’s exactly the moment to book a free consultation. We’ll find the best option you actually have.
Free, no-pressure help with aca / marketplace — in plain language.