Marketplace Pulse: Marketplace Premiums in 2026 if Enhanced Premium Tax Credits Expire
The Marketplace Pulse series provides expert insights on timely policy topics related to the health insurance marketplaces. The series, authored by RWJF Senior Policy Adviser Katherine Hempstead, analyzes changes in the individual market; shifting carrier trends; nationwide insurance data; and more to help states, researchers, and policymakers better understand the pulse of the marketplace.
***Note: Premiums in this article were pulled from insurers’ SERFF filings as of 7/21/25. These premiums are currently under review by state regulators and subject to change.
The recently enacted reconciliation bill has dire implications for health insurance coverage across the United States, with policies directed at both Medicaid and the marketplace that will result in an estimated 12 million losing their health coverage. Additionally, if Congress fails to extend the enhanced premium tax credits (ePTCs), 4.2 million more people are projected to lose their coverage. The marketplace will become not only smaller but more expensive as healthier people decide to exit. One estimate suggests that the combined effects of all of these policies could reduce the size of the marketplace by 40% or more, a major setback for a marketplace that has experienced rapid growth in recent years.
The impact of allowing the ePTCs to expire is becoming clearer as state insurance regulators review proposed premium increases for 2026. Rate filings submitted by insurers thus far suggest the largest rate increase for the individual market in more than five years. This steep price hike reflects the anticipation of a less healthy risk pool. Coupled with other measures in the reconciliation bill and the program integrity rule, 2026 enrollment is sure to be more complicated when compared to recent years.
National Impact: Premiums Consumers Pay Will Increase without ePTCs
For marketplace enrollees who make less than 400% of the federal poverty level (FPL), the potential expiration of the ePTCs poses a far greater threat than increases in insurers’ rates. For a 50-year-old enrollee at 300% FPL ($46,950 annual income), the end of the ePTCs means that their premiums will now be capped at 9.96% rather than 6% of their income. In most states1, 50-year-old marketplace enrollees at 300% FPL would see their premiums jump from $235 per month, for the benchmark silver plan, to $390 for the second-lowest silver plan, a 66% increase.
State Data: A Closer Look at Indiana and Washington: Insurers in Indiana and Washington have submitted their preliminary 2026 rates under the assumption that Congress will NOT extend the ePTCs. The rate filings do assume that Congress will fund cost-sharing reductions (which, as of the publication of this blog, Congress has not done). Below, we look at rates in each state.
Plan Year 2026 Indiana Preliminary Marketplace Rates
Overall for 2026, Indiana’s individual marketplace plans have requested an average rate increase of 20.5%. Indiana carriers only submitted one set of rates regardless of whether the ePTCs are extended by Congress. Indiana’s submitted rates assume that the individual market’s risk pool will be less healthy in 2026 after the expiration of the ePTCs.
Table 2 shows the difference in premiums with and without ePTCs for the lowest cost bronze and silver plan in each rating region in Indiana for a 50-year-old enrollee at 300% FPL. Without ePTCs, the lowest bronze premium in Indiana would be 83% to 102% more expensive for the 50-year-old individual at 300% FPL, and the lowest silver plan would be 69% to 77% more expensive.
Figure 1: Indiana Age 50, 300% FPL, PY 2026 Premium Differences for the Lowest Silver Plan with and without Enhanced Premium Tax Credits by County
The end of the ePTCs also means the end of any financial assistance for consumers over 400% FPL. For 50-year-old consumers enrolled in the benchmark silver plan in Indiana at 401% FPL, their premium would increase 23% to 50% if the ePTCs expire.
Plan Year 2026 Washington Preliminary Marketplace Rates
Due to the uncertainty around the ePTCs, some state regulators required that two sets of rates be submitted to allow for lower rates if the ePTCs are extended. Insurers in Washington requested an average annual increase of 21.2% in the event that the ePTCs are not extended and a somewhat smaller increase if they are.
Figure 2: Washington Age 50, 300% FPL, PY 2026 Premium Differences for the Lowest Bronze and Silver Plans with and without Enhanced Premium Tax Credits by County
Washington also had insurers apply a uniform cost-sharing reduction silver load adjustment factor to try to minimize the reduction in the tax credits for consumers under 400% FPL. Due to this policy, Washington’s insurers believe that they will be able to retain healthier subsidized enrollees and have requested rates even if the ePTCs expire in 2026. However, higher-income consumers face even higher premiums increases due to this adjustment. With the silver adjustment factor applied for Washington’s 2026 rates, a 50-year-old consumer at 401% FPL would pay 58% to 94% more for a benchmark silver plan in 2026 if the ePTCs expire.
1. Some states have state-level premium subsidies. Otherwise, the benchmark silver plan is the same premium nationally as tax credits bring the cost of the second-lowest silver down to a specific percentage of their income.
About the co-author:
Matthew Valeta is a data analyst with prior experience working for the California and Colorado marketplaces. At Covered California he led the development of the California Health Coverage Survey which continues to be conducted annually by NORC. Then at Connect for Health Colorado he led the relaunch of the marketplace's public website and implemented their 2020 open enrollment email and social media outreach campaigns. He currently works as a Health Plan Trainer for Denver Health Medical Plan. The data and findings in this article do not reflect the views of Denver Health Medical Plan. Matthew studied Political Science and Religion at Colorado College and received a Masters of Public Policy from the University of California, Berkeley in 2017.
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