Congress has just days to act on expiring health insurance tax credits — or risk 4.2 million Americans losing coverage, premiums skyrocketing 400%

Right now, the subsidies apply to people in the low- to middle-income range. For a single person, that’s roughly between $15,000 and $60,000 a year. People earning above that — starting at about $62,600 — don’t qualify for the same help, but they do benefit from a rule that limits their premiums to 8.5% of income [1].

If the credits aren’t expanded before the government funding deadline of September 30, the Congressional Budget Office (CBO) warns that premiums could rise when open enrollment begins on November 1, due to uncertainty about the future of ePTCs [2]. And it’s unclear if Republicans will heed the call from Democrats to expand ePTCs ahead of the New Year’s Eve deadline at all.

If the credits lapse, Americans could face skyrocketing premiums that leave 4.2 million uninsured by 2034, according to CBO estimates [3]. The non-profit Urban Institute, meanwhile, found that 7.2 million Americans could wind up without coverage [4]. Here’s what could happen to premiums if the credits expire, what politicians are saying and what people can do to protect themselves if they are afraid of losing health coverage.

How high could health insurance premiums go?

The Urban Institute estimates that if the subsidies expire, lower-income Americans could see premiums jump dramatically. For example, someone making around $23,000 to $30,000 a year could see their yearly costs rise from about $180 to $905. Those earning closer to $30,000 to $37,000 might see premiums climb from about $503 to $1,076.

[AARP reports that 92% of health insurance marketplace enrollees between the ages of 50 and 64 would face higher premiums without ePTCs [5].

Meanwhile, the Kaiser Family Foundation notes that people earning up to about $60,000 a year for a single person would still get some financial help if the subsidies expire — but their tax credits would be smaller, leaving them with much higher premiums. Anyone earning more than that would lose the credits entirely and have to pay the full cost of coverage on their own.

Democrats warned in a separate report that changes to Medicaid through the One Big Beautiful Bill could leave another nearly 11 million Americans without health coverage, increasing the overall number of Americans without coverage to 16 million within the next decade [6].

What are politicians saying about it?

Democrats have been raising the alarm about expanding the ePTCs ahead of the September 30 government funding deadline. Aside from avoiding rising premiums, the CBO report also noted that permanently expanding ePTCs by September 30 could result in almost 4 million more Americans gaining health coverage over the next decade.

They add that repealing sections of the 2025 budget reconciliation bill related to the ACA in that same timeframe could open the door to health insurance for an additional 2.9 million Americans by 2035.

Republicans, however, are currently divided as to whether or not they’ll extend ePTCs beyond this year. Some feel that letting the credits lapse could negatively impact their reputation heading into the 2026 midterms [7], while the attitudes of other GOP members range from a “wait and see” approach until after September 30 [8] to declaring a flat-out rejection of continuing the ePTCs [9].

What to do if you’re priced out of health coverage

For those worried about rising premiums and losing their health insurance, there are a few steps you can take to try and mitigate the blow.

High deductible plans paired with an HSA: High deductible plans generally offer lower premiums, so if you expect to stay relatively healthy then this could prove a good option. Adding an HSA to save money for if you do need to go into your own pocket to cover a deductible would be a helpful safety net, and can be done with or without a workplace plan.

Find a lower-tier plan: Lower-tier health plans don’t always offer as thorough coverage as the ACA marketplace plans, but Mizuho Americas financial group explains that lower-tier exchange or employer-sponsored plans can help with “softening but not eliminating the fallout” of lost ePTCs [10].

Save, save, save: Many people have emergency funds stashed away and, if you don’t already have one set aside for medical expenses, it’s a good time to start one. There are different options to choose from beyond HSAs, including high-yield savings accounts and FSAs — though with the latter, you have to use the money within the year or lose it. A financial professional could help determine which type of savings account works best for your needs.

Strategize: One financial planner told CNBC that it’s possible that those whose income exceeds 400% of the FPL, and who received ACA tax credits in 2025, could “consider accelerating 2026 income into 2025, tax-loss harvesting or claiming a deduction for health savings account contributions” [11]. It’s something that could be worth talking about with a financial adviser.

Preventative care: The healthier you stay, the less need you’ll have for expensive medical appointments and prescriptions. Eat well, exercise and attend annual checkups to minimize the chance of any medical issues getting out of control. It’s an investment in both your health and your long-term financial security.

The fate of these subsidies hinges on two key deadlines: September 30, when Congress must decide whether to extend them, and December 31, when they are set to expire. Open enrollment begins November 1, meaning Americans could soon see price hikes on the horizon even before the credits run out. Whether lawmakers act in time will determine what Americans pay for coverage in 2026 — and how many families stay insured.

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[1]. IRS. "Eligibility for the Premium Tax Credit"

[2]. CBO. "The Estimated Effects of Enacting Selected Health Coverage Policies on the Federal Budget and on the Number of People With Health Insurance"

[3]. CBO. "E&C Reconciliation Recommendations"

[4]. The Urban Institute. "Household Spending on Premiums Would Surge if Enhanced Premium Tax Credits Expire"