Expiration of Enhanced Premium Tax Credits Will Impact Older Adults, KFF Finds

A recent KFF report highlights the impact that the expiration of enhanced premium tax credits as of December 31, 2025 is having on Affordable Care Act (ACA) Marketplace enrollees over 50, who make up a large share of Marketplace enrollees (about one third of all Marketplace enrollees in 2023) and are disproportionately affected by the loss of this enhancement.

Why Older Adults are Disproportionately Affected

The report notes that all Marketplace age groups face dramatic increases in premium costs due to the expiration of enhanced tax credits, but the impact on those over 50 is particularly stark for three reasons.

First, people over 50 make up about half of individual market enrollees with incomes above 400% of the federal poverty level, meaning that they will not be eligible for any federal assistance. Second, while premiums in marketplaces cannot be increased as a result of preexisting conditions, they can be up to three times higher than the standard rate based on age. Lastly, while ACA enrollees may avoid some degree of premium increases as a result of the expiration of the enhanced credits by electing a lower-premium plan, the report notes that many ACA enrollees over 50 were already signed up for one of the lowest premium available to them and therefore had limited options to switch to a lower-premium plan.

Enormous Increases in Premiums

With the expiration, the average enrollee who received a premium tax credit faces a doubling of their premium payments for the same coverage. For older adults, the effects are often even more severe.

For a middle-income, 60-year-old individual, the report finds that premium costs have increased by over $10,000. In 2026, the national average annual unsubsidized premium payment for the lowest-cost bronze plan is $11,625, roughly 840% more than the subsidized level of $1,236. Before the expiration, this person spent about 2% of their annual income on a bronze plan, whereas now it would comprise 18% of their income.

The impacts of the premium increases will be different across the population of older adults—some may opt to drop insurance and delay care, while others, such as those with high health care needs, may be forced to cut other critical areas of their budget.

Worse Outcomes for Individuals and the Medicare Program

Any resulting coverage losses and care delays mean higher Medicare costs, as more people would enter the program in poorer health and needing more expensive interventions than they would have if they had better access to care. Across all age groups, the nonpartisan Congressional Budget Office (CBO) expects over 4 million people will become uninsured due to these price increases.