The stage is set for the most transformative period in the individual health insurance market since the inception of the ACA.
Expiration of subsidies
Fewer plan options
Shorter enrollment periods
Income verification
Increased premiums and out-of-pockets
Eligibility changes
Populations At Highest Risk
People earning above 400% of the Federal Poverty Level (FPL).
Under current law, the enhanced subsidies will vanish for households earning over roughly 400% of FPL, making them ineligible for premium tax credits in 2026.
Older adults (especially ages 50–64).
Older enrollees will see the steepest premium increases — many transitioning from $10 or free premiums up to hundreds of dollars per month.
Residents of non–Medicaid expansion states.
In states that have not expanded Medicaid (like Texas, Florida, Georgia, Mississippi, Kansas, etc.), households with incomes between ~100%–138% FPL now rely on marketplace subsidies. Without enhancements, many of them will lose both Medicaid and ACA coverage creating a coverage gap.
Low- to moderate-income households (up to 400% FPL).
The CBO projects as many as 2.2 million people may lose coverage in 2026 due solely to subsidy expiration.
Even those earning below 400% FPL will see their subsidies shrink significantly. Their out-of-pocket premiums could rise by 50%–75% or more, making coverage unaffordable.
Middle-class families in high-premium states.
Middle-income earners in states with already high premiums (like New York, Connecticut, West Virginia, Vermont, Wyoming) are expected to bear the brunt of rising costs if subsidies vanish.
Rural Americans and people of color.
Rural areas and red states — which saw market enrollment surge thanks to enhanced subsidies — are especially vulnerable. People of color, who disproportionately benefit from ACA tax credits, face disproportionate disenrollment risk.
But with disruption comes opportunity.
The time is now to protect and grow your business by offering the many alternative coverage options available – from affordable to comprehensive with broad networks and medium to low out-of-pockets.