The Affordable Care Act (ACA) Marketplace continues to serve as an essential path to affordable health insurance for many individuals and families. Starting later this year and into 2026 and 2027, new federal rules will change how the Marketplace works. These changes could impact your premiums, coverage eligibility, and what you need to do to keep your plan.
If you enrolled on your own without an agent, or if it has been a while since you reviewed your application, now is the time to prepare.
Upcoming Changes That Could Affect You
Subsidies May Decrease in 2026
Unless new legislation is passed, enhanced subsidies that lowered Marketplace premiums for many people are scheduled to expire at the end of 2025. Starting in 2026, the amount you are expected to pay toward your health insurance could increase based on your income.
Below is a comparison of the share of income consumers may be asked to contribute, based on income level as a percent of the Federal Poverty Level (FPL):
Below is 2025 Federal Proverty Level (FPL) Chart so you can see where you fall:
Here are two examples of the potential financial impact of the subsidy changes that could be coming in 2026:
Example 1: Someone Earning Between 133% and 150% of the Federal Poverty Level (FPL)
Single adult, income of $22,000 in 2025
- In 2025 (with enhanced subsidies):
They currently pay $0 per month for a benchmark Silver plan. - In 2026 (if subsidies expire):
They would be required to contribute 3% to 4% of their income, or roughly $55 to $73 per month for that same plan.
That is a new cost of $660 to $876 per year for someone living just above the poverty line.
Example 2: Someone Over 400% of the FPL
Single adult, income of $70,000
- In 2025 (with enhanced subsidies):
Thanks to the American Rescue Plan and Inflation Reduction Act, they pay no more than 8.5% of their income, which caps their monthly premium around $496 for a benchmark plan. - In 2026 (if caps are removed):
They would have no subsidy at all and must pay the full premium. Depending on age and location, that same plan could cost $750 to $900 per month.
That is a potential increase of $3,000 to $4,800 per year just because the income cap returns.
As you can see there could be significant increases if the enhanced subsidies are allowed to expire AND then if insurance companies increase premiums anticipating healthy enrollees will not renew policies.
Shorter Enrollment Window in 2027
Starting in 2027, the Open Enrollment Period will be shortened. Instead of running until January 15, it will end on December 15. If you miss that deadline, you will need a qualifying life event to apply for coverage. This will not start during this open enrollment so there is time to prepare.
Proof of Income May Be Required
If the income you report on your application does not match IRS records or if you are applying for coverage outside of Open Enrollment, you may be required to submit documentation. This includes proof of income or documents that confirm a qualifying life event, such as a job loss or a move.
$5 Monthly Charge for Some Plans
If you are on a $0 premium plan and do not actively renew your eligibility (this means update your application during open enrollment) , you could be assigned a $5 monthly premium in 2026. Missing this payment could lead to the termination of your coverage.
Tax Filing is Now Required to Keep Subsidies
If you received subsidy dollars in a prior year but did not file your taxes and reconcile them, you may lose access to premium and cost-sharing assistance. Previously, consumers had two years to reconcile; starting in 2026, just one year of non-filing will trigger a loss of help. What this means if you have not already filed income tax returns for 2024 do so before open enrollment in November.
Low-Income Monthly Enrollment Option is Ending
The Special Enrollment Period for people with income under 150 percent of the federal poverty level will end on August 25, 2025. After that date, a qualifying life event will be required to enroll outside of the Open Enrollment window.
Why Working with an Agent Helps
Working with a licensed agent doesn’t cost the consumer anything. Insurance companies pay the agent a commission for their services. The ACA Marketplace is changing in ways that could cause some people to lose their plans or face higher costs if they are not paying close attention. Working with a licensed agent helps you:
- Understand how the rules apply to your situation
- Submit documentation on time to avoid coverage gaps
- Review your plan and subsidy eligibility
- Get personalized help year-round
At ITK Insurance, we are here to make sure you stay in the know, stay covered, and stay prepared. If you are enrolled or know someone who is enrolled without an agent now is a good time to connect with us or any other licensed agent to help you navigate these changes.