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Nearly 5 million Americans are projected to lose ACA Marketplace coverage in 2026 after the enhanced premium tax credits that kept premiums affordable since 2021 expired on December 31, 2025. Average monthly premiums jumped from $113 to $178, a 58% increase, and deductibles rose by about $1,027 per person. Many people could not afford the new rates and dropped their plans.
If you are one of them, you are not out of options. Here is what to do right now.
First: Understand What Happened
The enhanced premium tax credits (ePTCs) were created by the American Rescue Plan in 2021 and extended by the Inflation Reduction Act. They reduced ACA premiums significantly — in some cases to $0 per month — for households earning up to 400% of the federal poverty level, and eliminated the “subsidy cliff” for higher earners entirely.
Those credits expired on December 31, 2025. Congress did not extend them. For most ACA enrollees, this meant their first January 2026 bill arrived at rates two to three times higher than what they had been paying. Many chose not to renew.
Losing coverage because you could not afford the new premiums counts as a life event that triggers a Special Enrollment Period in most states, which means you may have options to enroll in new coverage outside the standard November-January open enrollment window.
Your Options Right Now
Option 1: Check If You Qualify for Medicaid
Medicaid is free or very low cost health coverage for people below certain income thresholds. The income limit varies by state — in states that expanded Medicaid under the ACA, it is generally 138% of the federal poverty level ($20,783 for a single person in 2026).
If your income dropped at any point in 2026, you may now qualify even if you did not before. You can apply for Medicaid at any time — there is no enrollment window. Go to healthcare.gov or your state’s Medicaid office and apply online. Medicaid enrollment typically takes effect within 1 to 45 days depending on your state.
If you have children under 18, also check eligibility for CHIP (Children’s Health Insurance Program), which covers children in families who earn too much for Medicaid but cannot afford private insurance.
Option 2: Get on a Spouse or Partner’s Employer Plan
Losing coverage is a qualifying life event that triggers a Special Enrollment Period for employer-sponsored health plans. If your spouse or domestic partner has employer-sponsored health insurance, you typically have 30 days from the date you lost your ACA coverage to enroll in their plan.
Act quickly. The 30-day window starts from the date coverage ended, not the date you realized you were uninsured. If you are within the window, contact your spouse’s HR department immediately.
Option 3: COBRA
COBRA is only available if you had employer-sponsored coverage that ended. It allows you to continue that exact plan for up to 18 months, but you pay the full premium — the amount you paid plus what your employer paid — plus a 2% administrative fee. COBRA is typically very expensive but can be worth it for a short gap in coverage, especially if you have ongoing medical needs or are mid-treatment.
Option 4: ACA Marketplace with a Special Enrollment Period
Losing health coverage — including losing it because premiums became unaffordable and you dropped the plan — may qualify you for a Special Enrollment Period on the ACA Marketplace. Visit healthcare.gov and look for coverage loss as a qualifying life event.
The ACA plans are still available. The issue is cost without the enhanced subsidies. However, if your income is between 100% and 400% of the federal poverty level, you still qualify for some premium tax credits — just smaller ones than before 2026. Use the healthcare.gov calculator to check what you would actually pay.
Option 5: Short-Term Health Plans
Short-term health plans are not ACA-compliant, meaning they can deny coverage for pre-existing conditions, have benefit caps, and exclude certain treatments. They are significantly cheaper than ACA plans. The Trump administration extended the maximum duration of short-term plans back to 12 months with renewal options.
Short-term plans make sense as a temporary bridge — for example, while waiting for employer coverage to kick in or during a gap between jobs — but they are not a substitute for comprehensive coverage. If you have any ongoing medical conditions, read the exclusions carefully before enrolling.
Option 6: Health Sharing Ministries
Health sharing ministries are not insurance. They are membership organizations where members share each other’s medical costs. They are exempt from ACA regulations, meaning they can exclude pre-existing conditions, mental health coverage, and substance abuse treatment. Monthly costs are often lower than ACA premiums.
These are high-risk for anyone with chronic conditions or significant medical needs. Some members have reported large unpaid bills when their sharing community declined to cover certain claims. Understand exactly what is and is not covered before joining.
Option 7: HSA + High-Deductible Health Plan
If you enroll in a qualifying high-deductible health plan (HDHP) through your employer or the Marketplace, you become eligible to open a Health Savings Account (HSA). HSAs offer a triple tax advantage: contributions are pre-tax, growth is tax-free, and withdrawals for qualified medical expenses are tax-free.
The 2026 HSA contribution limit is $4,300 for individuals and $8,550 for families. If you are generally healthy and want to lower your monthly premium while building a tax-advantaged medical fund, an HDHP plus HSA is one of the most financially efficient setups available.
What to Do If You Have a Gap in Coverage
If there is a period where you have no coverage at all, take these steps to reduce your financial exposure:
- Delay non-urgent procedures until you have coverage again. Elective surgeries, non-emergency dental work, and routine screenings can often wait 30 to 60 days.
- Use urgent care instead of the emergency room for non-life-threatening issues. Urgent care visits cost $100 to $200 out of pocket versus $1,000 or more at an ER.
- Ask for the self-pay discount. Hospitals and many providers offer significantly reduced rates for uninsured patients who pay upfront. Always ask. The discount can be 30% to 60% off the standard billed rate.
- Look into community health centers. Federally Qualified Health Centers (FQHCs) charge on a sliding scale based on income and are available in most areas. Find one at findahealthcenter.hrsa.gov.
- Check for free prescription programs. GoodRx, Mark Cuban’s Cost Plus Drugs, and manufacturer patient assistance programs can dramatically reduce prescription costs while you are uninsured.
The Longer-Term Picture
Congress has shown interest in extending the enhanced subsidies. The House passed legislation in early 2026 that would preserve them for another three years, but the Senate outcome remains uncertain. If the credits are eventually restored retroactively or prospectively, the ACA Marketplace will become affordable again for many of the people who dropped coverage in 2026.
Monitor healthcare.gov and your state marketplace for updates. If subsidies are extended, there will likely be a special enrollment opportunity for people who lost coverage when premiums spiked.
Bottom Line
Losing ACA coverage in 2026 is not the end of the road. In order of what to try first:
- Check Medicaid eligibility — it is free and you can apply any time
- Get on a spouse’s employer plan if available — you have 30 days from coverage loss
- Check the ACA Marketplace for a Special Enrollment Period — subsidies still exist at some income levels
- Consider a short-term plan as a temporary bridge
- Use community health centers and self-pay discounts for any immediate medical needs
The worst outcome is going uninsured with no backup plan and facing a large medical bill with no coverage and no savings to absorb it. Any of the options above is better than that.
Sources: KFF Health Policy analysis on ACA enrollment and premium changes 2026; Centers for Medicare and Medicaid Services enrollment data; CNBC personal finance reporting May 2026; healthcare.gov. This article is for informational purposes only and does not constitute health insurance advice. Coverage options and eligibility vary by state and income.
