Dec. 31 will mark more than the end of 2025. Barring a holiday miracle, enhanced subsidies that have enabled millions of Americans to afford health insurance through the Affordable Care Act marketplace will also end when the clock hits midnight.
The “enhanced premium tax credits,” enacted during the pandemic in 2021 and extended in 2022, have helped more than double ACA enrollment to more than 24 million Americans in 2025. Currently, 93% of enrollees benefit from subsidies that offset some or all of their premium, according to the Centers for Medicare & Medicaid Services.
Four House Republicans joined Democratic colleagues this week in seeking to force a vote on extending the subsidies, but the vote would not come until January, after the enhanced credits expire. Even if it passes the House, it would face slim chances of success in the Senate.
How do ACA subsidies work?
The premium tax credit can pay for some or all of the premiums for marketplace health insurance plans, making them more affordable. You might also see these tax credits referred to as subsidies.
The initial premium tax credit has been in place since the first full year of ACA operation in 2014, and remains in effect. Since 2021, “enhanced” premium tax credits have been larger and more widely available within the marketplace.
These enhanced subsidies:
- Increased the amount of ACA tax credits.
- Removed the income cap to make more families eligible.
- Capped out-of-pocket premiums.
In 2024, enhanced premium tax credits made subsidized premiums about $705 less expensive per year, according to KFF, a health policy nonprofit.
The enhanced credits expire on Dec. 31, 2025. Smaller, un-enhanced tax credits go back into effect starting in 2026.
How much do enhanced subsidies cost the U.S.?
The Congressional Budget Office estimated in September that extending the enhanced premium tax credits would cost $350 billion over 10 years, while increasing the number of people insured by 3.8 million over current levels by 2035.
What happens when enhanced subsidies go away?
Prices for insurance through the ACA marketplace will more than double in the coming year, according to KFF, a health policy nonprofit, partly because of rising healthcare inflation but largely because of the end of the enhanced subsidies.
One result: Millions of Americans will lose or choose not to renew their health insurance, according to detailed analyses from both the CBO and KFF.
According to the CBO, ending the enhanced subsidies will result in 4.2 million additional uninsured Americans. Millions more could lose insurance coverage because of other changes to the ACA, some of which have been held up in court. In all, the CBO estimated in June, 8.2 million people could lose their insurance coverage because of changes to the ACA marketplace.
This comes on top of changes to Medicaid. All in all, 14.2 million more Americans might become uninsured by 2034, according to KFF analysis.
For those who stay insured: Prices are going up — often by hundreds of dollars per month. In some areas of the country, increases have been much steeper. On average, insurance policies obtained through ACA marketplaces have gone up 26% for 2026, according to a KFF analysis.
That’s only counting inflation. Once you factor in the end of enhanced subsidies, many policies are effectively doubling in price for current enrollees. KFF estimates out-of-pocket premiums will increase an average of 114% from 2025 to 2026 for people who receive subsidies.
While it's too early to tell with certainty, health policy experts believe many current enrollees will be forced to choose higher-deductible plans to absorb the higher costs.
What do you do if your costs are going up?
If your premiums are going up, it’s a good idea to shop around and compare your options. Plans’ prices and coverage can change every year, so there might be a better deal to be found if you change your metal level, company and/or plan.
If you’re still eligible for subsidies, you’ll probably want to stick with Silver plans. Silver plans can have lower premiums and out-of-pocket costs than other metal levels for people who qualify.
If you no longer qualify for subsidies, it could be worth looking at other metal levels on the health insurance marketplace. Bronze plans could help you save on premiums, but you’ll probably pay more out of pocket compared to Silver plans. And even Gold plans can be worth a look — sometimes they end up cheaper than Silver plans for people without subsidies.
Take extra care when looking at off-marketplace options such as short-term or limited-duration health plans, which might lack the coverage and consumer protections you’d expect from ACA-compliant insurance.
Note: ACA open enrollment for January 2026 ended Dec. 15. Enrollments for February 2026 are still open.
How did we get here, anyway?
Expiration of the subsidies has been a primary point of contention between the two wings of Congress for much of the year, and was one of primary issues driving the recent government shutdown.
The 43-day shutdown ended only when a group of Democrats broke ranks to join GOP Senators in signing a package of budget bills to end the shutdown. In exchange, they got a pledge to bring the extension of the enhanced ACA credits to a floor vote.
The promised vote happened but the measure fell short of the 60 votes needed in the Senate, however, as did a vote on an alternative GOP health care plan.
While there have been some bipartisan conversations on extending subsidies, none have resulted in a viable bill that can clear both houses of Congress before the credits expire.
The article The Door Is Closing on ‘Enhanced’ Affordable Care Act Subsidies originally appeared on NerdWallet.
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