Health insurance subsidies under the Affordable Care Act (ACA) have helped millions of Americans lower their premiums. But that extra help is set to expire in 2025—unless Congress steps in. Here’s what’s at stake and what you can do now to stay ahead of potential cost increases.
What’s Changing?
The American Rescue Plan Act and the Inflation Reduction Act temporarily expanded ACA subsidies, making coverage more affordable—even for many who didn’t qualify before. These enhanced subsidies are scheduled to sunset at the end of 2025.
⚠️ Important Policy Changes Ahead
- Open Enrollment Is Mandatory: You must re-enroll starting Nov. 1, 2025, to continue receiving financial help. If you miss it, your support may lapse.
- $5 Monthly Penalty for Missing Income Verification: If you don’t update your income info and submit documents during Open Enrollment, you may face an extra monthly fee—even if you’re already enrolled.
- Supporting Documents Required: To verify household income, you’ll need to upload proof like pay stubs, tax forms, or Social Security statements. This helps ensure your eligibility for subsidies in 2026.
- New SEP Limits for Low-Income Enrollees:
Beginning Aug. 25, 2025, enrollees earning under 150% of the Federal Poverty Level will no longer have a “monthly SEP” unless they qualify through a life event. This removes flexibility that many relied on. - Tighter IRS Verification Rules:
If tax data is missing or your income doesn’t match government sources, you won’t be able to self-attest. Exchanges will require third-party verification—and this policy extends through 2026.
Who Will Be Affected Most?
- Middle-income earners who currently benefit from premium caps
- Early retirees who don’t yet qualify for Medicare
- Freelancers and gig workers without employer coverage
- Families that just barely exceed old income thresholds
What Could It Mean for Your Premiums?
Without the expanded subsidies, some people could see monthly premiums double—or more. Those earning just above the federal poverty level may still get help, but middle-income families could feel the pinch.
What You Can Do Now
✅ Get a review of your current plan and income eligibility
Even if nothing’s changed in your life, your eligibility might shift if the enhanced subsidies expire. A quick review can clarify where you stand and whether you’re likely to qualify for a subsidy in 2026 under the older income thresholds.
✅ Consider locking in coverage with your current subsidy
If you’re eligible for a plan now with a significant subsidy, don’t wait. Locking in coverage during this year’s Open Enrollment could mean one more year of lower premiums—even if changes hit in 2026.
✅ Explore HRA or small group coverage if you own a business
Business owners (even sole proprietors) may be able to access better rates through group plans or HRAs (Health Reimbursement Arrangements). This could also apply if you’re an employee who declined your company’s plan in favor of marketplace coverage—now may be the time to reconsider your options.
✅ Follow updates—we’ll keep you posted
We’re monitoring what Congress does with the ACA subsidy extensions. If you’re subscribed to this newsletter, you’ll be the first to know what changes—and what to do next.
Bottom Line
Don’t wait for Congress to act. It’s smart to have a plan in place now so you’re not scrambling when prices jump.
👉 Know your options, lock in savings. Talk with Insureous today.