Posted in Healthcare
Written by Misa Bailey, Healthcare Program Manager at SC Appleseed
Blog Summary: In this blog, we discuss the changes in the Affordable Care Act (ACA) marketplace. The changes are from both the H.R.1 bill this summer and rule changes by announced by the Center for Medicare and Medicaid Services. Some of the rule changes will cause many South Carolinians to be priced out of health insurance this coming year. We share some things to keep in mind ahead of healthcare enrollment season starting November 1st.
Big changes are coming to the Affordable Care Act (ACA) marketplace that could affect your health coverage and costs in 2026. With open enrollment just around the corner, now’s the time to learn about the changes and prepare.
The 2026 Open Enrollment Period runs from November 1, 2025 through January 15, 2026. If you plan to apply or renew your health coverage through the ACA marketplace (HealthCare.gov), here’s what you need to know.
What’s Changing in 2026?
Premiums Will Skyrocket: Expiration of Enhanced Premium Tax Credits
Right now, most people who buy health insurance through the ACA marketplace get extra financial help, called Enhanced Premium Tax Credits, to lower their monthly premiums.
Unless Congress acts, extra financial help that lowers monthly premiums for people with ACA plans will end on December 31, 2025.
What Does This Mean?
- Monthly premiums for ACA plans will become unaffordable.
- In South Carolina, average premiums will rise by 98%, meaning an increase of $600 to $1,188 per year.
- Low-income families earning between 100 and 150% FPL will no longer have access to $0 or low-cost health plans.
- Moderate-income families earning above 400% FPL ($62,600 for an individual or $120,600 for a family of 4) will no longer qualify for any premium tax credits.
- Everyone will pay more for health care, including those with private insurance.
Watch our short video to learn more about how expiring tax credits will impact South Carolinians.
Who Will Be Hit the Hardest?
Everyone who buys health insurance through the ACA will see their costs go up, but some groups will feel the impact more:
- Older adults and families with low or moderate incomes who rely on these credits to keep coverage affordable.
- Small business owners and self-employed workers (over 80,000 in South Carolina) who depend on Marketplace plans.
- People in non-Medicaid expansion states like South Carolina, who have few other affordable options.
What Can You Do Now?
- Log into your HealthCare.gov account and check if you’re receiving tax credits.
- Use the KFF Subsidy Calculator to estimate what your 2026 costs might look like without the enhanced tax credits.
- Share your story about how enhanced tax credits have helped you. Email our storyteller at [email protected] to share today.
- Urge your Legislators to extend the Enhanced Premium Tax Credits before they expire!
You Could Owe More at Tax Time: Premium Tax Credit Repayment Limits Ending
Right now, there is a cap (or limit) on how much you owe back if you accidentally underestimate your income and end up getting too much financial help (premium tax credits) for ACA coverage. These limits were to protect people from unexpected and unaffordable bills at tax time.
But starting in 2026, these repayment limits are going away.
What Does This Mean?
- If your income ends up being higher than what you estimated, you’ll have to pay back extra credits you received.
- You could owe hundreds or thousands of dollars more when you file your 2026 taxes in 2027.
- There will be no cap on how much money you owe back to the government.
- Important: The“safe harbor” rule still applies. This means South Carolinians don’t have to repay money owed if their income falls below 100% the poverty line.
Who Will Be Hit the Hardest?
Everyone who buys health insurance through the ACA and receives premium tax credits (financial assistance) to help lower their monthly premiums will be affected, but some groups will feel a greater impact:
- Low-to-moderate income families who receive larger tax credits based on their income and are at higher risk of having to pay much more for premiums and out of pocket costs.
- Small business owners and self-employed workers who often have trouble estimating their income for the year.
- Those who experience unexpected life changes such as getting a new job or raise, qualifying for disability, or getting divorced.
What Can You Do Now?
- Try to correctly estimate your income for 2026. Underestimating your income can cost you big at tax time, with a large payback amount.
- Report income changes accurately and regularly throughout the year to minimize how much you could owe at the end of the year.
- Get help from a certified FQHC navigator, enrollment assister (InsureSC), or insurance broker if you’re not sure how to estimate your income for next year.
Less Time to Handle Income Issues with Insurers
Right now, people who apply or renew ACA Marketplace coverage and are asked to prove their income have up to 150 days to provide the required information.
Open enrollment period for 2026 only gives you 90 days to respond.
What Does This Mean?
- Your financial help (premium tax credits) or coverage will not start until you provide this information.
- In some cases, you might lose your benefits altogether if your income can’t be verified within these 90 days.
- Good to know: You can request a 60-day extension if you can show you made a good-faith effort to get the needed documents.
- Why would I be asked to verify my income? If the income you report on your application does not match your income in administrative records (such as a recent tax return).
Who’s Most Affected?
- People with seasonal, changeable, or self-employment income
- People with low incomes, disabilities, and seniors who may struggle to collect or submit documents
What Can You Do Now?
- Gather income documents now (pay stubs, W-2s, 1099s, or your 1040 tax return)
- Submit documents quickly if asked to prove your income.
- Ask for help from a certified enrollment assister or health insurance broker if you’re unsure what to submit.
Health Savings Accounts Will Be Allowed for All Bronze and Catastrophic Plans (But Be Careful)
Right now, only certain High-Deductible Health Plans (HDHPs) qualify for a Health Savings Account (HSA). A Health Savings Account is a special savings account that can be used to pay for medical expenses tax free.
These changes will start in 2026. You’ll be able to open a Health Savings Account (HSA) with any Bronze or Catastrophic health plan.
What Does This Mean?
- All Bronze and Catastrophic Plans offered in the healthcare marketplace can be paired with a health savings account
- If you’re able to, you can add more money to an HSA
- You’re able to spend your HSA on more medical services
- But these plans have very high deductibles and out-of-pocket costs
Who Should Be Careful?
- Low-to moderate-income households who might not have extra money to put into an HSA or would struggle to pay thousands of dollars before insurance kicks in.
- Individuals with chronic conditions who need regular care.
What Can You Do Now?
- Check your current coverage to see if you’re already enrolled in an ACA Bronze or Catastrophic plan
- Review your options to see if switching to one of these plans for 2026 fits your health needs and budget.
- Start thinking ahead about how much money you can add to an HSA in 2026
- Understand your risks if you’re thinking about a Bronze or Catastrophic plan with an HSA.
- Get help from a health insurance broker or enrollment assister to consider your options.
Final Tips for 2025 Open Enrollment
Open Enrollment for 2025 runs from November 1, 2025 through January 15, 2026.
- Shop and compare plans early. Don’t wait until the last minute to enroll.
- Use your benefits if you’re currently covered. Nothing is changing with your 2025 coverage so take care of check-ups, screenings, or procedures you’ve been putting off.
- Be ready for potentially large premium increases. Insurance companies will be informing consumers soon.
- Start gathering your pay stubs and tax return documents before open enrollment starts.
- Share your story and contact your legislators to let them know how this impacts you. There is still time for leaders to extend the enhanced tax credits that make health coverage within means for millions of Americans. You can use our action tool to send a message right now (click here). To share your story, reach out to our storyteller today at [email protected]
- Know where to find free, trusted help:
- HealthCare.gov: The official and most secure place to browse plans, apply, and manage your coverage
- Certified Navigators and Assisters: Free, community-based experts who can help you understand financial assistance, compare ACA plans, and apply.
- Palmetto Project is a local, trusted organization offering this kind of help statewide. Call (803) 779-4875 for Columbia office, or (843) 577-4122 for Charleston.
- Licensed Insurance Agents and Brokers: Certified experts who help you compare, select, and enroll in an ACA plan based on your needs at no cost to you.
- Avoid Scams: Only use official websites and work with certified Navigators, Assisters, or licensed Agents/Brokers. You should never pay for assistance reviewing ACA marketplace options. Find an assister or agent/broker near you. Make sure you are not being sent to a site that is selling non ACA plans.
Downloadable Tip Sheet for Enrollment
Thanks for reading. If you have questions, please feel free to email us at [email protected]. Stay tuned for more information on the ACA and healthcare changes ahead in our future blogs.
