Last month, House Republicans passed a tax and budget reconciliation bill that, if enacted, would raise health insurance premiums for millions of Americans who purchase coverage through the Affordable Care Act (ACA) marketplaces. A new Center for American Progress analysis makes clear that older adults would be hit especially hard—facing, on average, at least $1,200 more in annual premiums to keep their current ACA marketplace plan. In multiple states, premium hikes for adults 55 years old and older would exceed an average of $10,000—including a staggering $15,200 average increase in West Virginia and a $16,700 average increase in Alaska.
The American Rescue Plan of 2021 significantly expanded the premium tax credits that help consumers afford their ACA marketplace premiums. The law did so by increasing tax credit amounts and extending tax credit eligibility to more middle-income households by capping annual premium costs for all enrollees at no more than 8.5 percent of household income for the first time. When passing the One Big Beautiful Bill Act (OBBBA), House Republicans rejected an amendment to extend these enhancements beyond December 2025.
Additionally, the OBBBA includes a provision that would reverse “silver loading,” a premium pricing practice that began in 2018 after the first Trump administration halted federal reimbursements for cost-sharing reductions (CSRs) that lower out-of-pocket costs for low-income marketplace enrollees. Insurers were still required by law to provide CSRs, so most states responded by “loading” the cost to silver-tier premiums. Because tax credits are pegged to silver-plan premiums, this increase made the value of those credits more generous, enabling many enrollees to access free bronze plans or more affordable gold plans. Although the bill’s reversal of silver loading would lower the gross cost of silver premiums, it would also reduce the value of premium tax credits, effectively raising net premium costs for millions of marketplace enrollees. Initial text from the Senate Health, Education, Labor, and Pensions (HELP) Committee confirms that Senate Republicans propose codifying this provision in their version of the OBBBA, though the plan is undergoing changes in light of recent guidance from the Senate Parliamentarian on whether the text complies with Senate rules, and it is unclear whether the CSR provision can be somewhat modified and able to remain in the final legislation in a similar form.
Marketplace premium costs will spike for older adults
While adults of all ages would experience ACA marketplace premium increases as a result of the OBBBA, older adults would be hit especially hard. For example, a 55-year-old earning about $39,000 per year—250 percent of the federal poverty level (FPL)—would see their annual premium costs rise, on average, by about $1,300 for a benchmark silver plan. (see Table 1) A more affordable bronze plan would cost that 55-year-old roughly $1,700 more per year, and more comprehensive gold coverage would cost an additional $2,600 annually. A 60-year-old earning about $47,000 annually (300 percent of the FPL) could experience similar increases but with higher baseline premium costs.
People with household incomes above 400 percent of the FPL would lose any financial assistance for marketplace coverage. Accordingly, older adults with incomes above that level would absorb the steepest increases in premium costs to keep their plans. For example, a 55-year-old making about $62,800 (401 percent of the FPL) would have to pay almost $3,800 in additional premium costs for benchmark second-lowest-cost silver coverage, for a total of $9,100 in annual costs, and about $5,000 more in premiums for a bronze or gold plan. A 60-year-old with the same annual income could be hit with even higher increases: $5,700 in extra premium costs to keep their benchmark silver coverage, for a total of $11,000 in annual costs, and more than $7,300 in additional premiums for a bronze or a gold plan. (see Table 1)
Older adults in some states could pay at least $10,000 more in additional premium costs for ACA marketplace coverage
Older adults with identical incomes may face vastly different premium affordability challenges depending on where they live. For example, under the OBBBA, a 55-year-old making almost $63,000 per year (401 percent of the FPL) would pay, on average, more than $1,000 in higher premium costs to keep their current plan in every state except one—New Hampshire. (see Table 2) But in 34 states, that 55-year-old would have to pay more than $3,000, on average, to keep their coverage.
The financial hit becomes more severe as older adults move closer to retirement age. A 60-year-old adult making just under $63,000 per year (401 percent of the FPL) would have to pay an average of more than $3,000 in additional premium costs in 46 U.S. states to keep their current marketplace plan. (see Figure 1) In 32 states, those increases would exceed $5,000. And in four states, the added premium burden for a single 60-year-old would top $10,000—amounting to a staggering $15,200 increase in West Virginia and $16,700 increase in Alaska.
Conclusion
These sharp cost increases represent a real threat to older adults’ ability to access health care. If enacted, the House Republican proposal would effectively price many aging Americans out of the affordable coverage they rely on until they become eligible for Medicare.
Methodology
To assess the impact of expiring enhanced premium tax credits and the reversal of silver loading on ACA marketplace premium costs for older adults ages 55 and 60, the authors began with average 2025 premiums by metal tier from KFF and adjusted them for age using the standard age curve from the Centers for Medicare and Medicaid Services for all states except New York and Vermont, where premiums do not vary by age. To model premiums after silver-loading reversal, the authors reduced benchmark silver plan premiums by 12 percent, in line with May 2025 Congressional Budget Office (CBO) projections, and held bronze and gold plan premiums constant. While states vary in how they implement silver loading, this analysis assumes a uniform 12 percent downward adjustment as a result of the OBBBA.
To estimate what older adults would pay in premium costs in 2025 if the enhanced premium tax credits were not extended, the authors used CBO and Joint Committee on Taxation (JCT) projections of what premiums net of subsidy would be in 2025 based on the original ACA marketplace subsidy schedule. Income as a share of the FPL was calculated using the 2025 poverty guidelines published by the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation, including separate guidelines for Alaska and Hawaii.
The House bill includes a provision (Section 44202) that prohibits the use of CSR funds for health plans that cover non-Hyde Amendment abortions. Due to significant uncertainty around the policy and how states will react to the restriction, this analysis does not account for its potential impact.
This analysis does not account for the impact of the recently finalized marketplace integrity and affordability rule, which will go into effect in 2026 and is expected to marginally lower marketplace premiums while increasing cost sharing.