Millions of Americans will have to pay more for their health insurance in 2026 as enhanced tax credits that lowered the cost of Affordable Care Act (ACA) marketplace plans have expired. For many early retirees and individuals without employer-sponsored health care plans, this could mean thousands more in annual premiums.
For nearly 15 years, ACA plans, also known as Obamacare or public marketplace plans, have helped fill in gaps for people who either don’t have an employer health care plan or who don’t qualify for premium-free Medicare until age 65. As originally conceived, the plan premiums have depended on a variety of factors including age, location, and the level of coverage offered. But since 2014, Congress has offered a premium tax credit, or subsidy, to help make the plans more affordable to a broader set of people. Subsequent legislation passed during the COVID-19 pandemic expanded and extended this subsidy.1
As of January 2026, Congress let the expanded tax credits lapse. The premium increases particularly affect people who aren’t covered by an employer plan or who retire before they reach age 65, when they can enroll in Medicare.
Approximately 24 million people (5.5 million of whom are age 55 to 64)2 currently have an ACA plan, and 22 million receive some sort of premium subsidy, according to the nonprofit health policy organization KFF. On average, subsidized consumers have seen their health care premium payments increase about 114% as the enhanced premium tax credit expires, compared to a 26% premium increase for all insurer premiums in 2026, KFF notes.3
Unfortunately, there is no silver bullet to ease the pain of dramatically higher health care premiums. While it’s possible the expanded subsidies may ultimately get extended due to ongoing budget negotiations, people paying for marketplace plans will likely need to budget for higher premiums and higher health care costs in general.
Here are 6 things you can do to help plan for higher health insurance costs this year and next.
1. Budget for increasing costs
While Fidelity usually recommends having 3 to 6 months’ worth of expenses in reserve for emergencies, now may be the time to try to set aside even more if you can afford to do so. “If you’ve already got a budget, try to think of health care costs as part of your total spending, not a separate item,” says Alexander Concepcion, a senior associate for Fidelity’s Financial Solutions Team. “For example, if you typically spend $6,000 in out-of-pocket costs a year, you may choose to include $500 a month in your monthly budget for health care expenses.” If your health care spending is characterized by larger, more infrequent expenses, you may want to budget for more expenses earlier in the year, so you have the funds to cover them as they arise, Concepcion adds.
Budgeting for health care costs could be particularly important if you’ve retired early and are no longer continuing to save. As a reference point, according to the 2025 Fidelity Retiree Health Care Cost Estimate a 65-year-old person may need $172,500 in after-tax savings to meet health care expenses in retirement.4
2. Consider deductions that may lower MAGI
The premium tax credit for public marketplace plans is calculated through a household income-based formula based on modified adjusted gross income (MAGI) to determine whether, and to what extent, an enrollee will receive a subsidy for their health insurance premiums. Keep in mind that MAGI can be calculated in different ways for different credits and deductions, such as the premium tax credit for ACA plans.
Consider all possible deductions for which you may qualify that can help reduce your MAGI. Be aware that the standard senior deduction and the expanded senior deduction won’t reduce your MAGI for the purposes of the ACA premium tax credit. You can refer to Schedule 1 (Form 1040) Part II for a list of deductions that could help reduce MAGI. Such deductions could include:
Capital losses
Losses in general can reduce any capital gains income, such as from the sale of stocks or real estate, which contribute to adjusted gross income (AGI). And losses counted against ordinary income can help reduce your AGI, which factors into the calculation of your MAGI. If your capital losses exceed your gains in any given year, both single and married joint filers may reduce ordinary income up to $3,000 per year ($1,500 for married filing separately). Excess losses that exceed this amount can be carried forward to future years.
Find out more about using capital losses and tax-loss harvesting in Viewpoints: How to reduce investment taxes.
Contributions to traditional IRAs, workplace retirement plans, and health savings accounts (HSAs)
You may also be able to reduce your MAGI for premium tax credit purposes by making deductible contributions to a traditional IRA or by contributing to a pre-tax workplace retirement plan such as a 401(k), SEP IRA if you are self-employed, or to a nonretirement account such as a health savings account (HSA).
Keep in mind that traditional IRAs have income limits that determine whether your contributions will be deductible. To make HSA contributions, you must be enrolled in an HSA-eligible health plan. Note that your contribution limits are determined by whether you have individual or family coverage for your HSA-eligible health plan, and you cannot contribute to an HSA if you are enrolled in Medicare.
3. Make full use of your HSA
While you generally can’t use your HSA to pay for public marketplace health care plan premiums, recent tax legislation makes all public marketplace bronze and catastrophic plans HSA-eligible, which means you may now be able to contribute to an HSA even if you kept the same bronze or catastrophic plan that was not HSA-eligible last year. As a result, you can potentially use your HSA to cover qualified medical expenses incurred in these lower-premium plans, such as for doctor visits, screenings and diagnostic tests, and prescription medications. Note: HSA funds can be used to pay for health care continuation coverage such as COBRA, health care coverage while receiving unemployment compensation under federal or state law, and Medicare and other health care coverage if you are 65 and older.
If you’re covered by an HSA-eligible health plan, the HSA contribution limits for 2026 are $4,400 for self-only coverage and $8,750 for family coverage. Those age 55 and older who are not enrolled in Medicare can contribute an additional $1,000 as a catch-up contribution. If both spouses are enrolled in an HSA-eligible health plan, age 55 or older, and not enrolled in Medicare, they can each contribute a $1,000 catch-up contribution, but they must do so in separate HSAs.
4. Explore COBRA coverage
If you’re newly separated from your job, a federal law called the Consolidated Omnibus Budget Reconciliation Act (COBRA) allows employees to continue their employer-sponsored health plan for up to 18 months. That can be extended for longer periods for other reasons such as disability, divorce, or death of the covered employee, which would allow dependents to remain covered. Although COBRA is likely to be more expensive than what you paid for the same coverage while you were employed, its overall costs may still be cheaper than a public marketplace plan for which you receive either a low subsidy, or no subsidy for your premiums. COBRA could also be cheaper and offer more benefits—such as lower copays, deductibles, and coinsurance—than plans available through the public marketplace since it is the same health plan that your former employer negotiated.
Fidelity’s Health insurance before Medicare planning tool can help you understand the monthly and annual cost of COBRA and public marketplace health care plans in your area.
5. Think about itemizing medical deductions
There are 5 main categories of itemizable deductions, subject to various limitations, and if these categories add up to more than the standard deduction, you may want to consider itemizing if it makes sense. For 2026, married couples have a standard deduction of $32,200 and single filers a standard deduction of $16,100. Generally speaking, you can deduct medical expenses, home mortgage interest, state and local taxes, charitable contributions, and theft and casualty losses due to a federally declared disaster. Many deductions have limits, however. For example, you cannot deduct health care costs unless they exceed 7.5% of your adjusted gross income (AGI).5 Deductible expenses may include unreimbursed fees for doctor and hospital visits, dentists, chiropractors, mental health care, medical plan premiums for which you are not claiming a credit or deduction, and much more.
If you are losing some or all your premium tax credit subsidy in 2026, you may have significantly higher medical expenses than in past years, which may give you the opportunity to itemize deductions if you have not in the past. Alternatively, if you are typically an itemizer, be sure to include your unsubsidized ACA marketplace premiums in your medical expenses and, if they exceed the 7.5% AGI threshold, consider whether itemizing these expenses would be beneficial. For assistance with how to make the most of your medical expenses in your tax situation, consult a tax professional.
6. Consider switching to a lower-tier plan
ACA plans are ranked as platinum, gold, silver, bronze, and catastrophic. Platinum plans typically have the highest premiums and potentially the lowest out-of-pocket costs and deductibles, while bronze and catastrophic plans typically have higher costs. While switching to a lower-cost plan comes with numerous other costly tradeoffs, such as the potential for higher copays when you visit the doctor, coinsurance, and deductibles, you could switch to a marketplace plan with a lower premium, if this is suitable for both your health and financial situations. For example, switching plans, say to a less expensive bronze plan from a silver plan, could cut your monthly premiums to $456 from $611,6 but result in your plan's deductible increasing to $7,000 from $100 or less, KFF says.7
Also keep in mind that switching from a plan with higher premiums and lower out-of-pocket costs to a plan with lower premiums and higher out-of-pocket costs will result in fewer upfront expenses to maintain coverage, but you will likely spend more when you incur medical expenses. Further, when potentially switching plans remember that your doctors and prescription medications from a prior plan may not be covered.
Rising health care costs are on the table for everyone, and there’s no way to sugarcoat the increased expense. That’s why it may be helpful to talk with a tax or financial professional who can help you understand your options. Taking a hard look now at your finances could be the best medicine for the future.