ACA Subsidy Changes in 2026: What You Need to Know

All up and down social media here over the last few days as we approach January 1st, and the average American who has been used to taking enhanced subsidies, whose family income is maybe above 400% of the federal poverty limit, as the truth slowly begins to set in that their insurance premiums are going absolutely insane in 2026, there's a sense of panic across the board. All over Facebook, all over Instagram, people are freaking out, what do we do? One of the posts I saw recently, a gentleman and his family had a plan through a local carrier here in Wichita, has a $7,500 deductible, it's got a 50-50 split up to a $10,000 a year maximum that last year cost him about 600 bucks a month. And quite honestly, even a plan like that at $600 a month for a family of four or five still feels like I don't have very good insurance.

But in 2026, that same plan is now jumping to $2,400 a month and there's this idea that, oh my gosh, health insurance premiums have spiked and are out of control. Well, the truth of the matter is, health insurance premiums have always been out of control. What's changing as we move forward in 2026 is just the idea that federal tax money or subsidies that's funded through our tax dollars are going away. Now, the original part of the Affordable Care Act isn't changing and that original part of the Affordable Care Act is for people with household incomes between 100% and 400% of the federal poverty limit, the subsidies that are there, that part of the ACA is staying exactly the same.

What's changing is the enhanced subsidies. So the extra premium dollars that were being handed out during COVID and then during the Inflation Reduction Act have sunsetted at the end of 2025. So this plan that's now costing this family $2,500 a month last year was a similar premium. The only difference was they were leveraging close to $1,800 a month of Uncle Sam's money to help them pay for that.

And where does Uncle Sam get his money? Well, he gets it from guys like you and me who pay taxes. So we need to understand what's happening in the Affordable Care Act. Now, one of the craziest things that I've seen as I've followed these posts is the idea that folks are just gonna get rid of health insurance altogether.

They're just gonna cash pay everything. Matter of fact, one of the comments I saw earlier just simply said, out-of-pocket cost, here we come because we're just canceling it all, which feels really irresponsible if you have any assets at all. Truth of the matter is, if you have no assets, there's no reason for insurance because what are they gonna take? But if you've worked hard and you've developed a nest egg and you're trying to accumulate wealth for retirement or for your family or to pass it on to future generations, it is incredibly irresponsible to go uninsured.

So rather than throw the baby out with the bathwater, which is what a lot of these posts are recommending, hey, rather than us give $2,400 a month to Ambit or Blue Cross, we'll just keep that money ourselves and we'll pay for things ourselves. As fulfilling maybe as that sounds, what you don't recognize is there's some things you just can't pay for. It's the day you get stage four cancer or the time that you flip the four-wheeler going down the mountainside in Colorado and you spend some time in the hospital and now we've got two, three, four, $800,000 worth of bills. And yes, you can declare medical bankruptcy, but doing that, you'll liquidate many of the assets you've accumulated over the years.

So again, to solve the health insurance problem, we've got to be willing to think differently. And that's the beauty of education. That's the beauty of growth. We're always evolving to a better system, a better idea.

The idea in 2012 with the Affordable Care Act was to lump everybody together into one big risk pool. As those pre-existing conditions hit, they would just give federal tax money out to people based on their need to offset the cost. Well, that system seems to be failing horribly as we see posts like this where planned costs are jumping to $2,500 a year. But what's it look like if we were to look outside of traditional health insurance?

What does it look like for maybe using a direct primary care doctor, where you pay a set monthly fee, and you can see that doctor as much as you want? No longer are you seeing a doctor who's held hostage to health insurance, who's trying to run as many people through his medical practice as he possibly can in a nine-hour day. But instead, he's got a direct relationship with you, somebody you can talk to, somebody you can call, text, email, get access to care at the moment that you need it. Matter of fact, one of my employees today who uses a direct primary care doctor, who recently got out of having surgery, had some questions about her incision.

And she was able to get a hold of her doctor, text a picture of the incision to her doctor, who was then able to give her peace of mind to let her know that everything looks OK. Well, that's not found in traditional health insurance. That's found in direct primary care memberships. Or how about the idea of health care sharing ministries or medical cost sharing, who take the same idea of lumping people together to share their medical costs.

But rather than doing it through a health insurance piece, a piece that's regulated by Uncle Sam, a piece that's contractual, what does it look like if we do it through a voluntary membership? Many times, we can find some of the healthiest of the healthy people in those risk pools. Or what does it look like if we use a patient assistance program through a pharmaceutical company for the high-dollar medication? What most people don't recognize is a lot of these high-dollar medicines, based on your need, will provide patient assistance for you to be able to have access to that medication.

So rather than trying to solve the whole darn problem with one health insurance piece and a system that seems to be broken, if you're losing subsidies this year, rather than throwing the baby out with the bathwater, maybe it's time to think differently. Maybe it's time to evolve the way in which you put together health insurance strategies. So that's what we do at 316 Health Insurance. We help you identify, what are the different vehicles that I can use to help me solve the problem?

Maybe it's a cost-sharing program. Maybe it's a direct primary care membership. Maybe it's a fixed indemnity plan that's found outside of the Affordable Care Act. Maybe it's leveraging subsidies in the ACA.

The truth of the matter is, there's no one product that solves the problem for everybody. So what we have to do is we have to think differently. We have to find different pieces from different places and blend them together in ways that really, really work for you and your family.