The ACA’s enhanced subsidies are expiring at year’s end. Here’s what you need to know

By Tami Luhby, CNN

(CNN) — The cavalry is not coming to save the Affordable Care Act’s enhanced premium subsidies before they lapse at year’s end. And while the House is expected to vote in January on a Democratic proposal to extend them for three years, the effort faces significant hurdles in the Senate.

This means that millions of Americans will likely have to shell out more — in some cases, a lot more — for coverage in 2026 or go uninsured. They could also try to find less expensive policies, though those usually involve tradeoffs.

Extending the beefed-up subsidies has been at the center of several battles on Capitol Hill in recent months. Democratic lawmakers refused to fund the federal government this fall unless the subsidies were renewed, leading to a record-long shutdown that only ended in mid-November with an agreement to hold a vote in the Senate on the matter. Both Democratic and Republican health care bills failed to pass the chamber last week.

Moderate House Republicans fought with their leadership this past week over temporarily extending the more generous assistance. Four of them ultimately decided to go nuclear and back the Democrats’ proposal.

Here’s what you need to know now:

Is all premium assistance disappearing?

No! Only the enhanced premium subsidies enacted by the Biden administration as part of a 2021 Covid-19 relief package are expiring.

The original subsidies, which are in the 2010 landmark health reform law, will continue to be available. They limit monthly payments for the benchmark plan to no more than about 10% of enrollees’ household income for those earning less than 400% of the federal poverty level, or about $62,600 for an individual and $128,600 for a family of four.

But the enhanced subsidies made Obamacare coverage much more affordable, which helped draw a record 24.3 million people to sign up for 2025 policies. Lower-income Americans were able to enroll in policies with $0 or near $0 monthly premiums, while those in the middle class became eligible for help for the first time. Four out of five consumers were able to find 2025 plans for $10 or less a month.

Some Americans may also qualify for extra help from their states. Ten states provide eligible residents with additional state-funded subsidies that could blunt some of next year’s premium increase.

California, for instance, has allocated $190 million to replace the enhanced subsidies for many of its lowest income enrollees for 2026, said Jessica Altman, executive director of Covered California, the state-run exchange. However, that doesn’t come close to the $2.5 billion in federal enhanced subsidies that Golden State enrollees received this year.

In Massachusetts, residents with incomes below 400% of the federal poverty level qualify for longstanding state subsidies that will provide some additional aid, though most enrollees will still see their premiums rise, said Audrey Morse Gasteier, executive director of the Massachusetts Health Connector.

Nationwide, enrollees’ annual premium payments are expected to spike by more than $1,000 — or 114% — due to the lapsing of the enhanced subsidies, according to KFF, a nonpartisan health policy research group.

What should consumers do if they want 2026 coverage?

Shop!

Many Affordable Care Act enrollees allow themselves to be automatically renewed into the same plan year after year. But it’s more important than ever for consumers to log onto their exchange, update their estimated income and check out available plans. They can also get in touch with an enrollment navigator, insurance broker or agent to discuss their medical needs and budget to see what policies might work for them.

The phones have been ringing off the hook at the Covering Florida navigator program this enrollment season, said director Xonjenese Jacobs. It has already received more than 1,750 calls this year, compared to around 500 to 750 calls at this time last year.

Those whose premiums have skyrocketed beyond affordable levels could explore whether other insurers offer less expensive options or whether plans with higher deductibles and out-of-pocket costs have more reasonable premiums. They can check whether policies with narrower doctor networks or more restrictive HMO plans would reduce their monthly tab.

If consumers can’t afford any Obamacare policies, Covering Florida navigators also help them review alternatives to Affordable Care Act policies, such as short-term plans. But the navigators want to make sure that people consider plans that meet their medical needs since these alternatives typically don’t offer the comprehensive benefits and protections available in ACA policies.

More clients, however, are saying they have to forgo coverage for the coming year because of the higher premiums. In these cases, the navigators point them to federally qualified health centers that have sliding scale prices, Jacobs said.

“People are talking to you in real time while they’re literally trying to figure out what their next steps are going to be for their life,” she said.

“They’re saying, ‘I have to have this coverage.’ Or in some instances, they’re like, ‘I feel like it’s important for me to have health insurance, but I can’t afford this, so I need to figure out how I can make sure I continue to take care of my health care needs,’” Jacobs continued.

Covered California sent enrollees notices that included details about their current policy and subsidy amount but also listed another plan on the exchange with a lower premium so they could see that they have options, Altman said.

“Most people in Covered California … have plans available to them that cost less than the plan they have today,” she said.

While consumers should seek help if they feel they need it, they should also be aware of scams, said Devon Trolley, executive director of Pennie, Pennsylvania’s Affordable Care Act marketplace. Aware that people are concerned about premium hikes, fraudsters may try to push skimpier plans or fake coverage.

How is enrollment being affected?

The lapse of the subsidies is already taking a toll, say state exchange leaders. More people have been waiting to explore their options and to pick a plan in the hope that Congress will act before year’s end.

Several directors told CNN that new enrollment is down, terminations are up and more people are switching to less expensive plans, particularly bronze plans, which have lower premiums but higher deductibles and out-of-pocket costs. (Obamacare plans typically have four metal tiers, ranging from bronze to platinum.)

At Your Health Idaho, the number of new customers fell 22% from last year, while twice as many customers terminated their coverage, said Pat Kelly, executive director of the state-run exchange. People who disenrolled cited affordability at three times the rate of prior years.

Also, about 59% of enrollees selected bronze plans for 2026, compared to about 49% for this year.

“Any time you see a shift in the middle tiers, from gold and silver to bronze, it’s a pretty good indicator of affordability concerns,” Kelly said, noting that open enrollment ended on Monday.

In New York, consumers are flocking to the New York State of Health website, call center and navigators, but a smaller share are actually selecting plans, Danielle Holahan, executive director of New York State of Health, the state’s exchange, said. Last year, 70% of those found eligible for coverage went on to enroll. This year, the figure is 64%.

“There’s a lot of shopping and there’s less enrolling,” she said.

New sign-ups are also down considerably in Pennsylvania and California. Overall, the 21 state-based exchanges have seen an 18% decrease in new customers to 210,500 through November 22, according to data released by the Centers for Medicare and Medicaid Services. The federal exchange, healthcare.gov, which handles enrollment for 30 states, has experienced a slight uptick in such consumers to 739,000 through November 29, according to CMS, which did not respond to a request for comment.

Exchange leaders consider new enrollments a better indicator than returning consumers or total sign ups, in part because many states saw big jumps in enrollment for 2025 so they expect to see a larger number of returning customers.

Also, existing customers who are automatically reenrolled into 2026 policies may opt to end their coverage by not making premium payments next year. Those who actively enrolled may try to make some initial payments but find they can’t afford it and drop their policies.

Already, the share of Pennsylvania enrollees effectuating their 2026 coverage by making their first month’s payment is 10 percentage points lower than a year ago, Trolley said.

Several exchange directors told CNN they won’t have a good handle on 2026 enrollment — and the impact of the subsidy lapse — until April at the earliest. (Consumers who stop paying their premiums remain covered for three months before their policy is terminated.)

“There’s going to be a lot of coming and going,” Morse Gasteier said. “Particularly with respect to terminations, that may not be a clear picture right away.”

What if Congress extends the subsidies next year?

The leaders of state-based exchanges told CNN that they will be able to update their systems if Congress acts next month, though it may take time. A straightforward extension of the enhanced subsidies would be the quickest to implement. But if lawmakers make changes — such as setting an income limit or requiring minimum premium payments — it could take more time.

The state exchanges would let consumers know about the enhanced subsidy renewal and allow them to come back to sign up for coverage or to switch plans, leaders told CNN.

Massachusetts’ exchange could update its systems and notify consumers in about 15 days if Congress extends the enhanced subsidies with no changes in January, Morse Gasteier said, noting it has a “plan on a shelf.” The marketplace had to make changes to premiums and subsidies in 2021, when the enhanced subsidies were enacted.

Similarly, it would only take New York a week or two to adjust premiums and issue notices if the enhanced subsidies were simply extended, Holahan said. But the bigger challenge would be convincing those who terminated their coverage or opted not to sign up because of the premium spike to return to the exchange to look again.

“If we’ve lost them … getting them back, telling them that things have changed, it will be an uphill climb,” she said. “But we will do everything we can to outreach to them.”

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