When Eileen Tyrrell logged into New York state's health insurance marketplace in December, she says her monthly premium jumped from about $147 to $849.
"It was one of those moments where your stomach drops," says Tyrrell, 26, who earned about $53,000 in 2025 as a bookstore manager in Brooklyn. She expects to earn around $72,000 in 2026, including her bookstore salary and income from content creation on TikTok.
Last year, federal premium tax credits covered about $510 of Tyrrell's monthly premium, bringing the out-of-pocket cost of her Affordable Care Act bronze plan down to $147 a month. But between her higher income leading to a larger base premium and the expiration of enhanced pandemic-era subsidies, the same plan would cost her hundreds more per month.
The enhanced subsidies, first expanded in 2021 under the American Rescue Plan Act, removed the income cutoff for financial assistance and capped premiums at 8.5% of a household's income, allowing more middle-income Americans to qualify for help.
However, Congress did not extend the provisions beyond 2025. While premium tax credits can still lower monthly costs for some Americans, eligibility is limited to households earning up to 400% of the federal poverty level -- $62,600 for a single person in 2025 -- a cutoff that was temporarily eliminated under the enhanced subsidies.
Enrollees just above the cutoff now have to pay the full cost of their coverage, according to KFF, a nonpartisan health policy research group. This includes Tyrrell, whose projected 2026 income puts her at about 460% of the federal poverty level, based on the KFF's ACA marketplace calculator.
Nationally, the impact is already visible. Roughly 1 in 10 people who had ACA marketplace coverage last year are now uninsured, according to a March 2026 survey from KFF.
And for those keeping their existing plans, costs have risen sharply. A 2025 analysis by KFF estimated that premium payments for subsidized enrollees who stayed in the same plan would more than double on average after the enhanced tax credits expired.
"Losing ACA subsidies means breaking already fragile budgets for many people who are just starting in their careers and their financial lives," says Cynthia Luna, a certified financial planner based in Texas.
"This just gives people more hard choices to make," she says. "Food or medicine? Health-care coverage or savings?"
Just over 24 million people selected ACA marketplace plans for 2026, per KFF. The Congressional Budget Office estimates that about 2.2 million more people will be uninsured in 2026 than if the enhanced subsidies had remained in place, as higher premiums lead some to drop coverage or not enroll.