Roughly 28 million Americans were without health coverage in 2025 — and 2026 is on track to make that number worse. The expiration of enhanced ACA premium tax credits at the end of 2025 has already triggered the sharpest single-year Marketplace enrollment drop on record, with KFF estimating that 4.8 to 5.8 million more people could become uninsured this year alone. For insurance agents, this isn’t just a policy headline — it’s the single biggest opportunity of 2026 to help clients keep coverage and to grow a book of business.
Table of Contents
- The State of Health Insurance Coverage in 2026
- The 2026 ACA Subsidy Cliff: Why More Americans Are Losing Coverage
- The Role of Insurance Agents
- Educating Clients on Their Options
- Assisting with Enrollment
- Providing Ongoing Support
- What Brokers Should Do Now
- Frequently Asked Questions
- Sources
The State of Health Insurance Coverage in 2026
The Affordable Care Act (ACA) was implemented in 2010 with the goal of providing affordable health insurance options for all Americans. While the ACA helped bring the uninsured rate to a historic low, coverage gains have started to reverse. As of 2025, 8.3% of the population, or 28 million people, were without health insurance, according to the CDC’s National Health Interview Survey. That gap is even wider for low-income households, with 16.5% of those below the federal poverty level lacking coverage, per KFF.
The 2026 ACA Subsidy Cliff: Why More Americans Are Losing Coverage
The enhanced premium tax credits created under the American Rescue Plan and extended through 2025 by the Inflation Reduction Act expired on December 31, 2025 and were not renewed by Congress. The result has been the steepest single-year Marketplace contraction on record.
| Metric | 2025 | 2026 |
|---|---|---|
| Average ACA Marketplace enrollment | ~22.3 million | ~17.5–19.2 million |
| Average monthly premium payment (net of tax credits) | $113 | $178 (+58%) |
| Average Marketplace deductible | $2,759 | $3,786 (+37%) |
| Enrollees between 400%–500% FPL | Baseline | -44% enrollment |
(KFF)
KFF projects that 4.8 to 5.8 million people could ultimately lose coverage in 2026 as enrollees fail to pay the sharply higher premiums, and the Congressional Budget Office estimates the uninsured population will rise by an average of 3.8 million people per year from 2026 through 2034 if the enhanced credits aren’t restored (Healthcare Dive; Forbes).
Two groups are hit hardest:
- The “subsidy cliff” returns: consumers above 400% FPL who previously received tax credits under the enhanced formula now pay full price for Marketplace coverage — often thousands of dollars more per year.
- Lower-income enrollees who previously paid $0: under the reverted subsidy formula, some enrollees between 100%–150% FPL must now pay a premium for the first time in several years.
The Role of Insurance Agents
Insurance agents play a crucial role in helping individuals and families navigate exactly this kind of disruption. They are knowledgeable about the plans, subsidies, and enrollment rules available and can help clients find the most affordable option for their new financial reality. Insurance agents also handle the enrollment process itself, which has only gotten more complex as subsidy calculations, income verification, and plan-shopping strategy all changed heading into 2026.
Educating Clients on Their Options
One of the main ways insurance agents help is by educating clients on the coverage options available to them now that the enhanced subsidies are gone. Many consumers don’t realize that bronze or catastrophic plans, employer coverage, Medicaid (in expansion states), or a Basic Health Program (where available) might now be a better fit than staying in their prior Marketplace plan at a much higher price. Agents can walk clients through the real trade-offs between premium, deductible, and network access under the new pricing.
Assisting with Enrollment
Enrolling in a health insurance plan can be a daunting task, especially with new premium amounts, updated income thresholds, and shifting eligibility rules for 2026. Insurance agents can guide clients through the enrollment or re-enrollment process, help them accurately report income and household changes that affect their tax credit, and make sure paperwork is completed correctly and on time.
Providing Ongoing Support
Agents don’t just help with the initial enrollment; they provide ongoing support throughout the year. In 2026 specifically, that means helping clients understand new premium bills, catching missed payments before a 3-month grace period lapses and coverage is retroactively terminated, and helping them re-shop plans if their current option is no longer affordable.
What Brokers Should Do Now
- Proactively review your book of business for clients likely to be affected by the subsidy cliff (income above 400% FPL) or the reverted lower-income subsidy formula (100%–150% FPL)
- Reach out before clients receive a premium bill shock — explain the reason for the increase and what alternatives exist
- Help clients weigh bronze/catastrophic plans, employer coverage, or Medicaid against staying in their current Marketplace plan
- Track payment grace periods closely so returning clients don’t lose coverage retroactively for nonpayment
- Position yourself now for a wave of new clients who lost employer or Marketplace coverage and need help finding an affordable option
Frequently Asked Questions
Why did ACA premiums increase so much in 2026?
The enhanced premium tax credits created in 2021 and extended through 2025 expired on December 31, 2025 and were not renewed by Congress, so subsidy calculations reverted to less generous, pre-2021 levels.
How many people are expected to lose coverage in 2026?
KFF estimates 4.8 to 5.8 million people could become uninsured this year as a direct result of the subsidy expiration, on top of a broader CBO projection of 3.8 million more uninsured Americans per year through 2034 if the credits aren’t restored.
Is anyone still eligible for financial help on the Marketplace?
Yes. Financial help remains available for most enrollees between 100% and 400% of the federal poverty level, though the amount is generally lower than it was under the enhanced credit formula.
What should someone do if their new premium is unaffordable?
Talk to a licensed agent before dropping coverage entirely. Options can include switching to a lower-premium bronze or catastrophic plan, checking Medicaid or Basic Health Program eligibility, or reviewing employer-sponsored coverage.
Need Help Navigating 2026 Coverage Changes?
Affordable Care Agents helps licensed brokers grow their book by giving clients the guidance they need through major disruptions like the 2026 subsidy cliff — backed by carrier access, training, and full back-office support. Partner with Affordable Care Agents today, or contract now to get started. Call (646) 233-1499 or email [email protected].
Sources
- KFF — What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles
- Healthcare Dive — CBO Estimate on Enhanced ACA Subsidy Expiration
- Forbes — ACA Enrollment Could Fall By 5 Million as Enhanced Subsidies Expire
- BenefitsPro — Uninsured Rate Held Steady at 8.3% in 2025
- KFF — Key Facts About the Uninsured Population
ACA Marketplace Disclaimer
This article is for educational purposes only and does not replace official guidance from HealthCare.gov, your state’s Marketplace, or the IRS regarding premium tax credit eligibility. It does not imply government endorsement of Affordable Care Agents or its brokers. Subsidy amounts, eligibility rules, and plan pricing can change — always verify current figures directly with the Marketplace before advising clients.
