2026 Premium Shock: What’s Happening — and How to Stop It

Last updated: October 1, 2025

By Craig Crawford

Summary: About 24 million Affordable Care Act (ACA) enrollees are receiving renewal notices now. If Congress lets the enhanced premium tax credits expire on Dec. 31, 2025, many will face sharply higher out-of-pocket costs for 2026. Extending those credits keeps premiums where they are.

What’s happening right now

Roughly 24.2 million people selected ACA marketplace coverage for 2025 1, 2. Marketplaces send renewal letters each fall ahead of open enrollment (Nov. 1–Jan. 15) 3, which means notices are landing now.

Why premiums are at risk of jumping

Enhanced ACA premium tax credits (ARP/IRA) are scheduled to expire Dec. 31, 2025 unless Congress renews them. Nonpartisan modeling indicates that without renewal, average out-of-pocket premium payments would more than double for many enrollees next year 4.

Pennsylvania example

Pennsylvania’s Insurance Department reported approximately 19% average requested increases (before subsidies) in the individual market for 2026 5. Pennie, the state exchange, has warned that 2026 monthly payments will increase unless Congress acts 6. Practically: a middle-income enrollee paying about $4,000/year after subsidies in 2025 could see their net cost jump into the $7,000–$8,000 range if the enhanced credits lapse, because the subsidy cushion disappears on top of any base rate increase 4. The impact is often larger for older or rural enrollees.

Beyond Pennsylvania

  • Wisconsin: Reported potential increases up to 34% in 2026 without congressional action, with the end of enhanced credits cited as a driver 7.
  • Michigan: Citizens Research Council estimates roughly 70% marketplace premium increases if enhancements expire; state officials have begun consumer outreach 8, 9.

Timing: why notices are arriving now

Regulators finalize rates in late summer/early fall; exchanges run renewals in late September–October; open enrollment begins Nov. 1 3. That’s why letters and emails are going out this week.

What Does It Cost?

Keeping the extra discounts permanently runs about $350B over 10 years, per CBO. (Note: The tax cuts in the bill that cut these premium discounts “cost” at least 10 times more — $3.7 trillion over 10 years)

Sources

  1. CMS: 2025 Marketplace Open Enrollment Snapshot
  2. CMS press release: Over 24M consumers selected ACA coverage (2025)
  3. HealthCare.gov: dates & deadlines (Open Enrollment)
  4. KFF: Out-of-pocket payments would more than double if enhanced PTCs expire
  5. Pennsylvania Insurance Dept.: Proposed 2026 individual-market rate updates
  6. Pennie (PA exchange): costs & consumer notices
  7. Wisconsin: report showing plans could cost up to 34% more in 2026 without action
  8. Citizens Research Council of Michigan: impact if enhanced credits expire
  9. Michigan Governor directive (Aug. 8, 2025) on affordability

Trail Mix Briefs dig into the data behind the noise — short reads built for people who still like facts with their outrage. Written and researched for TrailMix.cc by Craig Crawford and team. Data verified by ChatGPT.