Affordable Care Act (ACA) enhanced premium tax credits expired at the end of 2025 and remain unavailable for 2027. Enhanced premium tax credits were introduced in 2021 and extended through the end of 2025 by the Inflation Reduction Act, but Congress has not renewed them for 2026 or 2027. The enhanced tax credits both increased the amount of financial assistance already eligible ACA Marketplace enrollees received as well as made middle-income enrollees with income above 400% of federal poverty guidelines newly eligible for premium tax credits.
Since the introduction of the enhanced premium tax credits, enrollment in the Marketplace has more than doubled from about 11 to over 24 million people, the vast majority of whom receive an enhanced premium tax credit. If enhanced tax credits expire, many Marketplace enrollees will continue to qualify for a smaller tax credit, while others will lose eligibility altogether and be hit by a “double whammy” of losing their entire tax credit and being on the hook for rising premiums.
Since 2014, the ACA has capped how much subsidized enrollees pay for their health insurance premiums at a certain percent of their income, on a sliding scale, with the federal government covering the remainder in the form of a tax credit. Enhanced tax credits work by further lowering the share of income ACA Marketplace enrollees pay for a plan. For example, with the enhanced tax credits in place, an individual making $28,000 will pay no more than around 1% ($325) of their annual income towards a benchmark plan. If the enhanced tax credits expire, this same individual would pay nearly 6% of their income ($1,562 annually) towards a benchmark plan in 2027. In other words, if the enhanced tax credits expire, this individual would experience an increase of $1,238 in their annual premium payments net of the tax credit.
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Table 1: ACA Marketplace Enrollees Will Pay More for Benchmark Coverage if Enhanced Tax Credits Expire Required Contribution Percentages With and Without Enhanced Tax Credits for an Individual.
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| Household income | Enhanced Tax Credits | 2027 Tax Credits | Annual Dollar Increase |
| $18,000 (115% FPL) | 0% ($0) | 2.1% ($378) | $378 |
| $22,000 (141% FPL) | 0% ($0) | 3.6% ($794) | $794 |
| $28,000 (179% FPL) | 1.2% ($325) | 5.6% ($1,562) | $1,238 |
| $35,000 (224% FPL) | 3% ($1,033) | 7.5% ($2,615) | $1,582 |
| $45,000 (288% FPL) | 5.5% ($2,475) | 9.6% ($4,311) | $1,836 |
| $55,000 (351% FPL) | 7.3% ($4,010) | 10% ($5,478) | $1,469 |
| $65,000 (415% FPL) | 8.5% ($5,525) | No tax credit | Varies |
| Note: FPL stands for Federal Poverty Level. Required contribution percentages refer to the maximum share of income ACA Marketplace enrollees are required to pay for a benchmark plan. The "2027 Tax Credits" scenario represents the required contribution percentages that will be in place for 2027 if enhanced tax credits are not renewed. Premium increases will vary for enrollees with incomes over 400% of poverty based on family size, age, and location. | |||
A previous KFF analysis, based on data released by the federal government, showed the enhanced premium tax credits saved subsidized enrollees an average of $705 annually in 2024, bringing their annual premium payment down to $888. Without the enhanced premium tax credits, annual premium payments in 2024 would have averaged $1,593 (over 75% higher than the actual $888). More recent data have not been released.
Based on the earlier federal data and more recent other publicly available information, KFF estimated that keeping the enhanced premium tax credits would have saved subsidized enrollees $1,016 in premium payments over the year in 2026 on average. Instead, with the enhanced premium tax credits expired, subsidized enrollees' average annual premium payment jumped 114% from $888 in 2025 to $1,904 in 2026 - and that higher, non-enhanced payment level carries into 2027 as well. (The average premium payment net of tax credits among subsidized enrollees held steady at $888 annually in 2024 and 2025 due to the enhanced premium tax credits).
The same higher, non-enhanced contribution levels that took effect in 2026 remain in place for 2027, and premiums are rising further on top of that:
Insurers are proposing additional rate increases for 2027, on top of the roughly 18% median increase enrollees already saw in 2026.
The Congressional Budget Office estimates gross benchmark premiums will rise about another 7.7% in 2027 even without further policy changes.
Many healthier enrollees left the Marketplace in 2026 as their subsidies shrank or disappeared, leaving a smaller, somewhat sicker risk pool - a trend that is contributing to continued rate increases for 2027.
Congress has not passed an extension of the enhanced premium tax credits as of this writing. Unless that changes, the standard, non-enhanced required contribution levels shown in Table 1 above remain in place for 2027, and middle-income enrollees whose payment for a benchmark plan is capped at 8.5% of their income - or who have lost financial assistance altogether above 400% of poverty - continue to be responsible for the full cost of any premium increases.
Enrollees across the income spectrum can expect big increases in premium payments
Enrollees with incomes above 400% of poverty remain responsible for the full cost of coverage in 2027. On average, a 60-year-old couple making $85,000 (or 402% FPL) saw their yearly premium payments rise by over $22,600 in 2026 after losing the enhanced tax credits, bringing the cost of a benchmark plan to about a quarter of this couple's annual income, up from 8.5% previously - and that couple can expect a further increase on top of that amount in 2027 as premiums keep rising. Meanwhile, a 45-year-old earning $20,000 (or 128% FPL) in a non-Medicaid expansion state, whose premium payments for a benchmark plan rose from $0 to $420 per year in 2026 from the loss of enhanced premium tax credits, can expect a smaller but similar increase in 2027. About half (45%) of ACA Marketplace enrollees have incomes between 100-150% of poverty, about a fourth (28%) have incomes between 150-250% of poverty, and roughly 1 in 10 have incomes above 400% of poverty.
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