Costs of Healthcare and Healthcare Inurance
With the Affordable Care Act (ACA) enhanced premium tax credits expiring January 1st, 2026, many Americans enrolled in ACA exchange plans were facing increasing significant premium payments. CBO (Congressional Budget Office) did project a permanent extension of the enhanced tax credits would result in increases in the number of people with health insurance by 3.8 million in 2035.
Without the extension, the CBO anticipated insurers on the individual market would raise rates with the expectation that some healthier people would drop coverage rather than pay a significantly higher monthly amount. The total number of people who have enrolled in the ACA Marketplaces and paid for at minimum one month of coverage won’t be available until the summer of 2026.
More likely than not, many people did drop healthcare insurance due to increasing cost due to the lack of subsidies and the increasing premiums.
To keep the same plan people had in 2025, KFF did estimate the enrollees’ contributions to their premium payments increasing by an average of 114% after premium tax credits. Even with the increases a KFF poll did reveal many Marketplace enrollees would maintain some form of health insurance coverage in spite of the rising premiums payments. The available data suggests the signups remain strong. I suspect people chose less costly plans.
And as expected 70% of respondents stated, increasing premium payments for their current coverage (doubled) would cause them look for a different Marketplace plan. A plan offering a lower premium and higher out-of-pocket expenses. Enrollees can find a less expensive premium by switching to a lower metal tier plan with a higher deductible. For example, going from a Gold to a lower cost Silver plan. There is a tradeoff that exists when individuals switch between silver and bronze plans.
Some Background on ACA Premium Tax Credits 2025 to 2026
In 2025, 93% of Marketplace enrollees received some form of premium tax credit subsidizing coverage. With enrollees who receiving Advanced Premium Tax Credits (APTCs), the average monthly gross premium (total premium including both the enrollee portion and federal subsidy) was $619, but the average subsidized enrollee paid only $74/month after APTCs.
In 2026, the average monthly gross premium for a benchmark (second-lowest cost) silver plan is $625, and the average gross monthly premium for an individual’s lowest-cost bronze plan option is $456.
The Disappearing Subsidies
There is a large swing from 2025 to 2026 dues to subsidies which disappeared the end of 2025.
Enhanced tax credits allowed Marketplace enrollees making between 100%-150% FPL (federal poverty level) eligible for a fully subsidized benchmark silver plan. Prior to the enhanced APTCs, enrollees making just above the poverty level were expected to contribute about 2% of their household income towards a benchmark plan. The expiration of the enhanced premium tax credits, households will again pay a percentage of their income.
ACA healthcare plans are tiered by actuarial value (“metal levels”). This reflects the average amount of expected expenses a plan will cover for a typical enrollee. Gold plans have high premiums and cover health costs with low out-of-pocket payments for enrollees.
Silver plans are the most common with approximately 70% Actuarial Value (amount of medical expenses annually paid by the plan). Bronze plans cover around 60% AV. Also, Bronze plans generally cover a smaller portion of total health expenses, (high deductible health plans). Bronze plans can offer tax advantages through health savings accounts.
In 2025, ~56% of Marketplace enrollees chose a silver plan. Bronze is the second most common plan. In 2025, 30% of Marketplace enrollees chose a bronze plan. People earning under 150% of the federal poverty level could qualify for zero-premium silver plans. When taken as an APTC, the subsidy is applied to the premium at the time of payment. This will reduce the monthly out-of-pocket expenditure for premiums. In the absence of enhanced APTCs, people may still qualify for zero-premium bronze plans. A a bronze plan has tradeoffs and no upfront cost sharing.
Cost Sharing
2026: The average deductible is $5,304 for a silver plan and $7,186 for a bronze plan. Cost-sharing reductions (CSRs) decrease the amount of cost sharing (deductibles and copays/coinsurance) individuals must pay when they use care. Enrollees with an income below 250% FPL can receive some level of CSR when they purchase a silver plan. Such increases the actuarial value to a level comparable with or better than higher metal levels. Bronze plans are not eligible for CSR. In 2025, 53% of Marketplace enrollees received some form of CSR subsidizing their coverage
The average benchmark silver plan deductible in 2026 is reduced from $5,304 to $80 for those with incomes below 150% of the federal poverty level, $790 for those with incomes between 150% and 200% of poverty, and $3,727 for those with incomes between 200% and 250%.
However, healthcare costs have been increasing. As a result, deductibles are increasing too. Four in ten insured adults under the age of 65 (38%) also have concerns about affording their monthly health insurance premium. Large shares of adults with employer-sponsored insurance (ESI) and those with Marketplace coverage rate their insurance as “fair” or “poor” when it comes to their monthly premium and out-of-pocket costs to see a doctor.
Unfortunately, the ACA is a healthcare plan which has little capability of controlling cost for plans which are administered by private companies. Costs are passed to the subscribers which happens with Medicare Supplemental plans also. Even Medicare experiences cost increases. It is about time, healthcare and healthcare insurance be re-evaluated.
Thoughts and ideas?
moral: we need single payer Medicare for all.
AND then we need to explain to young people that if they pay more into Medicare while they are young and “don’t need it” they will have paid for what they need when they are old and can’t pay for it. This would be true of private insurance too if you could find a private insurer who would take such a deal and be around when you need them.
AND we will need an honest Congress…or independent Administration..to keep it honest and control prices. Too bad about all the private insurance companies. They had their chance to provide honest insurance at a reasonable cost. I’m sure the lower level workers will be able to find steady jobs in the new Medicare.
But then we’d have to explain what government is for…to the people and to their representatives. Good job for a citizens assembly to study,,,even now,,,in case we get rid of the trumpists in time to save our country from being…no longer “becoming”…the new Evil Empire.