Shoppers of Affordable Care Act Coverage Are Already Being Hit With Sticker Shock

While the Affordable Care Act (ACA) open enrollment period does not begin until November 1, Americans across the country are already seeing the consequences of Congress’ failures to extend enhanced premium tax credits. Marketplace window shopping is open in several states, and premium sticker shock is already rattling households as they review their coverage options for 2026.

Contrary to House Speaker Mike Johnson’s (R-LA) claims that the expiring tax credits are “an issue for the end of the year,” consumers across the country are already confronting skyrocketing premiums and difficult choices about whether they can afford their health insurance. Several states are previewing 2026 premiums, insurers’ renewal notices are imminent, and Americans with marketplace coverage are considering options now. Lawmakers must act immediately to keep people insured and preserve affordability by extending the enhanced premium tax credits.

The enhanced premium tax credit fight

The enhanced premium tax credits—first enacted under the American Rescue Plan and extended through 2025 by the Inflation Reduction Act—lower the cost of coverage for the more than 20 million Americans who receive financial help with marketplace plans. By increasing the generosity of subsidies and capping premiums at 8.5 percent of household income for those above the previous eligibility limit of 400 percent of the federal poverty level (FPL), the enhanced tax credits made coverage more affordable for millions of low- and middle-income consumers. Notably, the changes enabled households with incomes from 100 to 150 percent of the FPL to obtain silver plan coverage for $0, which will no longer be the case if the enhanced subsidies expire.

Currently, the enhanced tax credits are set to expire on December 31, 2025, and congressional Republicans declined several opportunities to extend them as part of the Big Beautiful Bill that passed in July. Marketplace insurers priced 2026 plans expecting that the enhanced credits would end, and millions of Americans will face higher premium costs as a result. A KFF analysis found that if the enhanced tax credits expire, average premium costs would more than double for 20 million Americans; and the Center for American Progress previously estimated that average premium costs would spike by 300 percent in some states. The nonpartisan Congressional Budget Office estimates that letting the enhanced tax credits expire would increase the number of uninsured Americans by about 4 million by 2034.

2026 sticker shock is already here

To date, state-based marketplaces in Georgia, Idaho, Maryland, Nevada, New York, and Virginia have opened their window-shopping tools for 2026. These tools allow consumers to preview plan options and premium prices before open enrollment begins on November 1. The early sticker shock offers a glimpse of what will soon become reality for millions more Americans with marketplace coverage, unless Congress acts to extend the enhanced tax credits.

Premium increases depend on individual household characteristics and plan selections, but examples using state marketplaces’ window-shopping tools show how costs will rise for illustrative households who keep the same silver plan from 2025 to 2026:*

• Virginia: A 51-year-old and 50-year-old couple from Roanoke with a household income of $85,000 would see their premium cost rise from $602 to $1,410 per month—a 134 percent increase.
• New York: A family of four in Rockland County with a household income of $105,000 would see their premium cost rise from $1,809 to $3,101 per month—a 71 percent increase.
• Nevada: A single 61-year-old in Las Vegas earning $68,000 would see their premium cost rise from $505 to $1,179 per month—a 133 percent increase.
• Georgia: A single 45-year-old Atlanta resident with an income of $38,000 would see their premium cost rise from $185 to $477 per month—a 158 percent increase.

The road ahead for 2026 open enrollment

This timeline highlights key dates and deadlines across the HealthCare.gov platform and the state-based marketplaces, showing when enrollees will feel the full impact of rising premiums and why urgent congressional action is needed to keep coverage affordable.

The authors would like to thank Brian Keyser for his fact-checking assistance.

* Authors’ note: The authors conducted marketplace plan window shopping on October 8, 2025. Information on the illustrative household characteristic inputs is on file with the authors.