Premium Spikes on the Horizon
After a failed set of Senate proposals last week to address the expiration of enhanced Premium Tax Credits (ePTCs), consumers are still waiting for a resolution to the imminent health care affordability crisis. Current ePTCs expire on December 31, 2025, which will leave enrollees with dramatically higher healthcare costs in 2026. This week, the House voted to pass a bill that unfortunately did not address this crisis. Despite bipartisan action to address tax credit extensions, Speaker Johnson has indicated that there will not be a vote on this measure until early January.
Health Affairs gives a recap of the previous Senate and House proposals. The proposal that passed in the House this week focused on expanding association health plans, one of the plan options that do not provide comprehensive coverage and are exempt from antidiscrimination protections which ensure coverage for people with disabilities. Analysis in Health Affairs outlines the limitations of this approach, reinforcing the importance of ePTCs to ensure affordable care. The Center on Budget and Policy Priorities (CBPP) outlines the limitations of the current House bill which leaves out ePTC extensions. Congress will be on holiday recess starting today, returning the week of January 5th.
In response to upcoming price hikes, Families USA developed an explainer on what ACA marketplace enrollees need to know about their options for 2026 coverage. Make sure to remind enrollees that they will still likely be eligible for some level of tax credit when enrolling. This includes individuals making less than $62,600 annually. This is even higher for families as a family of 4 would still be eligible for premium tax credits if they are making less than $128,600 annually. Depending on their state of residence, enrollees might be eligible for additional state subsidies as well. Some people who select a silver plan will be eligible for additional cost-sharing reductions which may lower their deductible, copayments, and/or out-of-pocket maximum.
Enrollees are likely seeing a barrage of advertisements to sign up for junk plans, which do not offer the same protections as comprehensive insurance coverage available through the Marketplace. Any plan being advertised that asks for an individual’s health history is likely a non-ACA plan. The only sure way to get an ACA compliant plan that offers full coverage is to go to healthcare.gov or your state’s health insurance exchange. It’s important to reinforce the benefits that ACA plans still offer, including the availability of free preventive services, the guarantee that preexisting conditions will stay covered and provide coverage for essential health benefits. People who have traditionally auto-enrolled should be encouraged to check their portal to make sure they’re still going to be enrolled in the best coverage option available. Those that are not planning to enroll next year should also check to make sure they’re not set to auto-enroll in a plan for 2026.
Enrollees who signed up before January 1st can still elect to change their plan until the end of Open Enrollment on January 15th. Congress may still act to extend the enhanced premium tax credits in January, which could give consumers more options to seek affordable coverage on the Marketplace. Citizens can check out this guide from Families USA to call their representatives to urge action for extending the enhanced premium tax credits to ensure affordable coverage is available in 2026. People impacted by rising healthcare costs are encouraged to share their stories for inclusion on the page as well.
Tracking Medicaid Work Requirements
Medicaid enrollees will be facing new work requirements to retain their coverage starting in 2027 and states will begin developing the rules and processes for implementing this in 2026. This will be a challenge for many people with disabilities, even though some will be technically exempt from the requirement. Over the coming year, Kaiser Family Foundation will be tracking the state-level rollout of these requirements. You can check the tracker for state-level impacts and policies affecting your enrollees. AAHD will continue to monitor and report developments related to Medicaid work requirement implementation.
A Note from our Team – AAHD will be closed for the holidays through January 2nd. Our next issue of this newsletter will be released January 9th. The final deadline to enroll in coverage this Open Enrollment season is January 15th, for coverage to begin on February 1st.
Archives of our weekly updates are available on the NDNRC website. Follow AAHD’s other newsletters to stay current on research opportunities and policy developments supporting people with disabilities.