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Enhanced Premium tax credits

KFF Health News: Congressional Stalemate Creates Chaos for Obamacare Shoppers

8 Things to Watch for 2026 ACA Open Enrollment

The ACA Marketplace Open Enrollment season begins November 1, and with it comes looming changes to the enhanced premium tax credits, increases in out-of-pocket premiums, and changes to Marketplace enrollment and eligibility rules.

Quick Take: ACA Insurers Are Raising Premiums by an Estimated 26%, but Most Enrollees Could See Sharper Increases in What They Pay

ACA Premium Payments Would More than Double on Average If Enhanced Tax Credits Expire

Calculator: ACA Enhanced Premium Tax Credit

Timely insights and analysis from KFF staff

Jun 10, 2025

The Biggest Rollback in Federal Support for Health Coverage Ever

Larry Levitt

Republicans are not talking about repealing and replacing the ACA anymore, and the budget reconciliation bill doesn't do that, at least not directly. However, the bill would restrict health insurance for many people who have been helped by the ACA, and it would be the biggest rollback in federal support for health coverage ever. ... more
Jun 10, 2025

An Additional 8.2 Million People are Expected to Be Uninsured from Changes in the ACA Marketplaces

Jared Ortaliza

ACA Marketplace changes are technical and numerous but consequential. While more attention has been focused on cuts to Medicaid, upcoming changes to the ACA Marketplaces could lead to just as many people losing health insurance coverage. ... more
May 23, 2025

Last-minute House Reconciliation Provision Would Set Up Clash with States over Marketplace Abortion Coverage

Laurie Sobel

Insurers in 12 states that require abortion coverage would not be able to access federal funding for reduced cost-sharing under the House provision. How this would get resolved, and what would happen to abortion coverage for low-income ACA enrollees in these states, is unclear. ... more

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If I mis-estimate my income and end up earning more than 250% of the federal poverty level next year, will I have to pay back the cost-sharing subsidies?

Sep 29, 2025
FAQs

No. Unlike premium tax credits, which are reconciled each year based on the income you actually earned, cost-sharing reductions are not reconciled.
How much are the cost-sharing reductions?

Sep 29, 2025
FAQs

It depends on your household income and where you live. To give a general idea, a typical Silver plan might have an annual out-of-pocket maximum on all cost sharing of $10,600 in 2026.
If I use my premium subsidy for a Bronze plan, I can save even more money on the premium. Can I also get my cost-sharing reduction through a Bronze plan?

Sep 29, 2025
FAQs

No. You can only get cost-sharing reductions by enrolling in a Silver Marketplace plan. You will not receive cost-sharing reductions if you enroll in a Bronze, Gold, or Platinum plan. Note that this is different from the rule for premium tax credits. You can apply premium tax credits to all four types of plans.
I can’t afford to pay much for deductibles and co-pays. Is there help for me in the Marketplace for cost sharing?

Sep 29, 2025
FAQs

Yes. If your household income is between 100% and 250% of the federal poverty level ($15,650 to $39,125 annually for a single person in 2026, or $32,150 to $80,375 for a family of four), you can qualify for cost-sharing reductions if you choose a Silver plan.
The insurance my employer offers is not affordable, so I enrolled in a Marketplace policy with premium tax credits. However, I later got a part-time job and now my annual income will be higher than I originally estimated. At this higher income, the cost of enrolling in my employer-sponsored plan is now considered “affordable,” but I can’t sign up for my employer plan until the next open enrollment season. What should I do? When I file my taxes will I be required to pay back my premium tax credits because I had access to affordable job-based coverage after all?

Sep 29, 2025
FAQs

First, you should report your income change to the Marketplace as soon as possible. The Marketplace will determine your new eligibility for premium tax credits based on your higher income and adjust the amount of tax credits going forward.
I estimate my income next year will be very low, so I need my premium tax credit all paid in advance. If, by the end of the year, it turns out my annual income was even lower than I expected and I could have qualified for Medicaid, will I have to repay the advance premium tax credit paid on my behalf?

Sep 29, 2025
FAQs

No, your final premium tax credit amount will be determined based on your income for the year as reported on your tax return.
I had Marketplace coverage in 2025 and have to reconcile my taxes for this year. What’s the most I would have to repay the IRS for tax credits paid on my behalf?

Sep 29, 2025
FAQs

For the 2025 tax year, if you underestimated your income and received a larger advance premium tax credit than you were eligible for, you must repay the difference between the amount of tax credit you received and the amount you were eligible for.
Can I adjust the level of subsidy I collect in advance when my income goes up or down during the year? How often during the year can I make adjustments?

Sep 29, 2025
FAQs

You can make adjustments during the year whenever you need to. There is no limit to the number of times a person may report income, family, or insurance-eligibility changes to the Marketplace. Changes that you report will be verified by the Marketplace.
I am self-employed and my income varies from year to year. How do I apply for premium tax credits if I don’t know what my income will be next year?

Sep 29, 2025
FAQs

When you apply for the premium tax credit, you will be asked to estimate your expected income for the upcoming year. Often a good place to start is to consider what your income is this year, or what income you reported on your tax return last year.
I am married, but my spouse and I live apart, and we do not file a joint tax return. Instead, I use the “married filing separately” tax filing status. I have a low income and need help paying health insurance premiums. Can I qualify for premium tax credits?

Sep 29, 2025
FAQs

Generally, no. Married taxpayers are required to file a joint tax return in order to qualify for premium tax credits. People who use the “married filing separately” status are not eligible to receive premium tax credits. However, there is a special exception for individuals who must file separately because of domestic abuse or spousal abandonment.