After Congress allowed the Affordable Care Act’s (ACA) enhanced premium tax credits to expire at the end of 2025, millions of Americans are paying significantly more for their health insurance in 2026. From 2025 to 2026, average monthly net premium costs among marketplace enrollees rose by 58 percent ($780 per year), from $113 to $178; the average deductible increased by 37 percent ($1,027) from $2,759 to $3,786; and from February 2025 to February 2026, marketplace enrollment declined by 13 percent.
Recently, the Trump administration announced a one-time, $500 check for nearly 1 million marketplace enrollees who do not receive premium assistance—mostly those with incomes above 400 percent of the federal poverty level (FPL). But these checks pale in comparison with the enhanced tax credits these people would have received if President Donald Trump and Congress had not failed to extend them. The result of these policies is that these people are paying thousands of dollars—in some cases, more than $10,000—in premiums. Millions of lower- and middle-income ACA enrollees whose costs also increased will get nothing. The proposal falls far short of addressing the broader affordability challenges facing marketplace consumers.
Against a $780 average annual increase in premium payments and a $1,027 increase in deductibles, spread across the 19.2 million marketplace enrollees, President Trump has promised a one-time, $500 check for nearly 1 million enrollees with the highest incomes. Over 10 years, that’s a $500 million solution to a $350 billion problem.*
The administration’s $500 refund plan
The White House claims the $500 checks will be funded through a surplus of federal marketplace user fees—the assessment that insurers pay to fund HealthCare.gov, its call center, its enrollment systems, and consumer outreach. The fee is assessed as a percentage of premiums and collected directly from issuers. The president said his administration was “giving the money back to the people who were wrongly ripped off.”
Details about how the refund will be implemented remain unclear. The existing statute and regulations governing the marketplace and its user fees do not establish a mechanism for providing these fees as direct rebates to individual enrollees, and the administration has not yet made public an executive order establishing the program.**
$500 would fail to blunt premium shock while doing nothing for low- and moderate-income enrollees
As proposed, the checks will be issued to enrollees in the 30 states on the federal platform who receive no premium assistance.*** Many of these enrollees had incomes above 400 percent of the FPL in 2025, the basis year for 2026 coverage: $62,600 for an individual, $84,600 for a household of two, and $128,600 for a family of four. These households benefited from the enhanced tax credits, which capped premiums for benchmark silver plans at 8.5 percent of income with no upper income limit, before the Trump administration and Congress let those credits expire at the end of last year and repeatedly rejected efforts to extend them. $500 is little relief for most enrollees in this category, whose premiums have likely increased by thousands of dollars—in some cases, more than $10,000—in 2026. (see Table 1)
Roughly 1.5 million enrollees in these states received no premium assistance through March 27, 2026.**** The administration has not explained why approximately one-third of those unsubsidized enrollees will be left out of the refund.
For enrollees earning just above 400 percent of the FPL, $500 covers a tiny fraction of their premium increases. Based on estimates of U.S. averages from KFF’s ACA Enhanced Premium Tax Credit Calculator, a 60-year-old earning $65,000 per year will pay more than $10,000 more this year for the same plan they had last year. The check will cover less than 5 percent of that increase. A 55-year-old couple at $85,000 per year saw their premium contribution more than triple, from $7,225 to $26,153. The check will cover less than 3 percent of that increase. A family of four at $130,000 per year pays $12,910 more. The check will cover about 4 percent of that increase.
Millions facing higher costs will receive nothing
The proposal excludes millions of lower- and middle-income marketplace enrollees whose premiums also increased after the enhanced tax credits expired. A single adult earning $28,000 per year will pay, on average, about $1,237 more this year; a family of four at $75,000 per year will pay about $3,367 more; a family of four at $45,000 per year that paid nothing for coverage last year now owes about $1,607. Because these households still receive tax credits, all of them are disqualified from the refund.
Higher costs are also affecting the plans that consumers select and whether they remain insured. In 2026, 9.2 million people selected bronze plans, up from 7.3 million in 2025. These plans generally offer lower premiums but expose consumers to higher deductibles. Marketplace enrollment also fell by nearly 3 million people between February 2025 and February 2026, the largest single-year drop since the marketplaces opened in 2014.
Reducing premiums beyond a one-time payment
The administration already has the tool for the problem it claims to be solving. When user fees are over-collected, the remedy is to lower the fee, which reduces premiums for every unsubsidized enrollee, every year, automatically. The Centers for Medicare and Medicaid Services (CMS) said as much in February 2025, when it cut the Navigator program and noted that the savings would let the exchanges “reduce the user fee in future years, which would translate into a reduction in premium.” It then did exactly that, finalizing a 2027 user fee of 1.9 percent, below the 2026 rate of 2.5 percent.
President Trump should instruct CMS to lower the exchange user fee rate to an appropriate level rather than sending checks to a small number of people, in mostly red states, weeks before the midterm elections.***** But the checks are only a distraction. The much larger problem—unaddressed by the president—is large premium increases that are harming struggling families and pushing people out of coverage.
Conclusion
Families struggling to afford health insurance need relief that reflects the scale of the costs they face. A one-time, $500 check will cover only a fraction of the premium increases many eligible enrollees face and will provide nothing to millions of others whose costs have also risen. To actually address higher premiums for marketplace enrollees, President Trump should tell Congress to restore the enhanced premium tax credits, which would reach all 19.2 million people in marketplace coverage rather than the 5 percent that the administration selected. It would also bring back people who have been driven out of the marketplace. An estimated 4.8 million more people would be insured in 2026 with the enhanced credits.
A premium tax credit adjusts every year to a household’s income and its premium, meaningfully lowering costs for marketplace enrollees year after year. A one-time check does none of that and is spent before the next premium increase is announced. That is the choice in front of Congress and the president.
* 19.2 million is the effectuated enrollment in ACA exchange plans according to the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, as of April 15, 2026.
In September 2025, the Congressional Budget Office estimated the cost of permanently expanding the enhanced premium tax credit structure to be $350 billion from 2026 to 2035.
** As of 10:00 a.m. EDT on September 16, 2026.
*** The announcement from the White House was unclear as to whether eligibility will be based on 2025 or 2026 premium assistance.
**** Based on Center for American Progress analysis of CMS 2026 Marketplace Open Enrollment Period State-Level Public Use Files, March 27, 2026. Total enrollment minus advance premium tax credit enrollment equals 1,531,248 unsubsidized enrollees.
***** Based on CAP analysis of CMS 2026 Marketplace Open Enrollment Period State-Level Public Use Files, March 27, 2026. Among the 30 states using the federal marketplace platform (HealthCare.gov), 26 states containing 1,439,316 unsubsidized marketplace enrollees (94 percent) were carried by the Republican nominee in the 2024 presidential election. Only four states (Delaware, Hawaii, New Hampshire, and Oregon) containing 91,932 unsubsidized marketplace enrollees (6 percent), were carried by the Democratic nominee.