Yes, there has been a tremendous amount of chatter regarding the ACA Subsidies going away in the news lately. It does seem like my answer is always as simple as “yes” or “no” depending on your personal situation. Here’s some good news, nearly 80% of all Americans will still be eligible for subsidies based upon their household income, even if the “enhanced subsidies” do indeed go away for plan year 2026. That being said, yes, many have the potential of losing 100% of the current subsidies they are now receiving. Here’s the bottom line, IF you are earning in Household Income above and beyond the 400% threshold, you are in great jeopardy of losing ALL of your subsidies. I personally am one of those individuals, and yes it ouches! And if you’re under the 400% threshold, then you are in the “Safe Zone” and likely moderately affected. Yes, the chart at the bottom of this article should be your guideline.
Why is this happening?
This may surprise most, that the ACA-ObamaCare has now been around for 15 plus years. Originally, it was designed to “subsidize” most folks that did not have access to a group health coverage and earning less than the 400% of the FPL-Federal Poverty Level based on your household income. Covid-19 reached America in the spring of 2020, continuing to cause significant disruption throughout 2021. In January of 2021 Congress passed the American Rescue Plan Act which greatly expanded the subsidies on the ACA. This was designed to alleviate the pain and the crisis that many Americans who had lost their jobs were feeling during the heart of Covid. The intent at the time was for the years’ 2021 (started actually in April) and then expire at the end of 2022 for a total of nearly two years. Then, late in September of 2022 the Inflation Reduction Act extended these “enhanced subsidies” for three more years through 2025. So, without any new laws passed, these “enhanced subsidies” are naturally falling off the books. And this is what all the talk is about lately. In general, we will be reverting back to the way it was designed and the way it was for an entire decade with the 400% threshold prior to Covid-19. And YES, it is not only the 400% threshold, but additional subsidies across the board that did indeed give more subsidy dollars to “enhance” the impact in healthcare coverage. So, here’s the end result, many will be adversely affected and can expect significant monthly premium increases. We will need to cross that bridge in November. The new rates for 2026 are generally not posted until then. If you are a current client or exploring please call in November.
What if I lose all of my subsidies and my rate goes up tremendously?
As always, my job is to provide options for you and your family. If you are in the category of greater than the 400% threshold, then you may wish to call sooner than later. Here’s the backup plan, A Short-Term Medical plan via Allstate Health Solutions with the Aetna nationwide network, which will be a great alternative for those in good health. Yes, you will need to be in good health and free of any serious or significant pre-existing medical conditions. If you feel you may qualify, then premiums are about half of the full price of a typical ACA policy. Sadly, not everyone in this situation will find this to be the right answer. Again, and as always, my job is to continue to explore on your behalf and offer the best options available in the marketplace.
This open enrollment with all the “unknowns” will no doubt be a challenging one. I will continue to monitor the situation with all the government shutdown as well as any new laws or extensions that may be on the horizon. My best guess, ultimately it will be a compromise of the way it “was” and the way it currently “is.” And yes, I do realize that is a not a definitive answer.
Federal Poverty Level Chart
| Household Number | 400% of US Federal Poverty Level for 2025 (these rates will likely be adjusted for inflation for 2026 so may not be exactly accurate) |
| 1 | $62,600 |
| 2 | $84,600 |
| 3 | $106,600 |
| 4 | $128,800 |
| 5 | $150,600 |
| 6 | $172,600 |
| 7 | $194,600 |
| 8 | $216,600 |
Best regards,
Kevin F. Gourgues
This is a new addition to the “What the Health?” newsletter that I will try to keep brief and to the point. Hopefully, this may help shed a little light on a somewhat complex health insurance world.
You’ve got Q’s, I hope I have your answer! Always feel free to call Kevin most anytime. Text or call 985-778-0072.