22 million Americans woke up today to the same question: Will my health insurance still be affordable after January 1st?
Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services (CMS), confirmed on November 16th that “there are discussions” about extending the enhanced Affordable Care Act (ACA) premium subsidies. Those subsidies expire December 31, 2025. Without them, average premiums jump 114%.
That’s not a typo. If you pay $400 monthly now, you’d pay around $856 starting January. For families, that means choosing between health coverage and groceries.
Fortune reported Oz’s comments during a November 16th briefing, where he acknowledged the urgency but provided zero concrete timeline. “We are aware of the concerns and are working to address them,” he said—bureaucrat-speak for “we’re talking about it.”
Why Your Premiums Could Double in 6 Weeks
The enhanced ACA subsidies weren’t always this generous. Congress created them as temporary COVID-19 relief in 2021, then extended them twice—most recently through the end of this year.
Here’s what they do: Lower your monthly premium based on income. A family of four earning $80,000 annually might pay $300 monthly instead of $1,200. The federal government covers the $900 difference.
When the subsidies expire December 31st, that $900 disappears. You’re back to paying full freight.
The numbers break down like this:
- 22 million Americans currently receive enhanced subsidies through ACA marketplace plans across all 50 states plus Washington D.C.
- Average premium increase: 114% if Congress doesn’t act before year-end.
- Affected income range: Individuals earning up to $60,000 and families of four earning up to roughly $125,000 (depending on state and plan type).
Dr. Oz’s comments suggest the Biden administration is pushing for extension, but he stopped short of guaranteeing anything. “The situation is being closely monitored,” he told reporters—another non-answer that does nothing for your January budget.
What Happens If Subsidies Expire (Spoiler: It’s Bad)
Let’s get specific about the financial hit.
If you’re a 45-year-old earning $55,000 in Texas, your current Silver plan costs about $250 monthly with subsidies. Starting January 1st without extension? Around $535 monthly. That’s an extra $3,420 annually—roughly a month’s rent for many Americans.
Families face worse math. A couple with two kids earning $90,000 might see monthly premiums jump from $450 to $963. That’s $6,156 more per year.
Three likely outcomes if subsidies die:
- Millions drop coverage entirely. The Kaiser Family Foundation estimates 3-4 million people would go uninsured rather than pay doubled premiums. That puts financial risk directly on your household—one medical emergency bankrupts you.
- Marketplace enrollment crashes. Fewer enrollees means higher premiums for everyone who stays, creating a death spiral where only sick people keep coverage and rates skyrocket further.
- Emergency room costs surge nationwide. Uninsured Americans still get sick. They just show up at ERs, which pass costs to taxpayers and insured patients through higher hospital bills.
Dr. Oz acknowledged this reality somewhat: “We are committed to ensuring that Americans can afford health insurance.” But commitment without congressional action is worthless on January 1st.
The Political Mess Behind Your Premium Spike
Why hasn’t Congress already extended the subsidies?
Politics, naturally. Republicans argue the subsidies cost taxpayers too much—roughly $50 billion annually according to Congressional Budget Office estimates. Democrats counter that uninsured Americans cost the healthcare system even more through emergency care and lost productivity.
Both sides have valid points. But you’re stuck in the middle, facing a 114% premium increase regardless of who wins the argument.
The timing makes this worse. Congress typically extends these subsidies at the last minute, creating maximum uncertainty for families trying to budget for next year. Open enrollment for 2026 coverage runs through mid-January in most states, meaning millions must choose plans without knowing final costs.
Dr. Oz’s November 16th comments suggest discussions are happening at CMS, but the actual decision sits with Congress. The Centers for Medicare & Medicaid Services can’t unilaterally extend subsidies—that requires legislation.
Translation: Don’t hold your breath for quick resolution.
Should You Enroll Now or Wait?
You’re probably wondering: Do I enroll in 2026 coverage now, or wait to see if subsidies get extended?
Enroll now. Here’s why:
Most state marketplaces let you change plans during special enrollment periods if subsidy rules change. If Congress extends subsidies in January, you can switch to a better plan or adjust your current coverage. But if you wait and subsidies DON’T get extended, you might miss the enrollment deadline entirely and go uninsured.
Check your state’s specific rules on HealthCare.gov. Some states have extended their deadlines specifically because of subsidy uncertainty.
When comparing 2026 plans right now:
- Calculate premiums both ways. Use the marketplace calculator to see costs with and without enhanced subsidies. This shows your worst-case scenario.
- Prioritize high-deductible plans if subsidies expire. Lower monthly premiums matter more when you’re paying full price. You can always upgrade to richer coverage if subsidies return.
- Check if you qualify for Medicaid instead. Some states expanded Medicaid eligibility. If your income dropped or household size changed, you might qualify for free or low-cost coverage regardless of ACA subsidy status.
One more critical point: Subsidies are calculated on your estimated 2026 income, not your 2025 income. If you expect a raise or job change, factor that into your marketplace application. Underestimating income means you’ll owe money back when filing taxes.
What Insurance Companies Are Doing Behind the Scenes
Health insurers aren’t sitting idle during this mess.
They’ve already filed 2026 premium rates with state regulators based on the assumption subsidies will expire. That’s the 114% increase you’re seeing in preliminary quotes. But many insurers built contingency plans into their rate filings that allow automatic adjustments if subsidies get extended.
From the insurer perspective, subsidy expiration creates two big problems:
- Enrollment drops mean lost revenue. Fewer customers = less premium income, even if rates are higher per person.
- Risk pools deteriorate fast. When only sick people keep coverage because healthy people drop out due to cost, insurers face higher medical claims relative to premiums collected. That’s unsustainable and forces further rate increases in 2027.
America’s Health Insurance Plans (AHIP), the industry trade group, has lobbied hard for subsidy extension. They know marketplace stability depends on keeping enrollment high through affordable premiums.
But insurers can’t control congressional politics any more than you can. They’re stuck waiting like everyone else.
State-by-State Impact: Who Gets Hit Hardest
Not all states face equal pain if subsidies expire.
States that didn’t expand Medicaid under the ACA—including Texas, Florida, Georgia, and others—will see the worst enrollment drops. Residents in those states have no Medicaid safety net, so losing ACA subsidies means going completely uninsured for many.
States with their own marketplace exchanges (California, New York, Massachusetts) have slightly more flexibility to create state-level subsidies, but that requires legislative action and state budget dollars most don’t have.
Rural areas suffer disproportionately regardless of state. Marketplace competition is already limited in many rural counties—sometimes just one insurer offers coverage. When subsidies disappear and enrollment drops, insurers might exit those markets entirely, leaving residents with zero marketplace options.
Check your county’s insurer options for 2026 on your state marketplace. If you see only one or two insurers, you’re particularly vulnerable to coverage gaps if the market destabilizes.
Frequently Asked Questions
When do the enhanced ACA premium subsidies expire?
The enhanced ACA premium subsidies expire December 31, 2025. Unless Congress passes legislation extending them before year-end, your January 2026 premiums will reflect the full unsubsidized cost. Open enrollment for 2026 coverage continues through mid-January in most states, but subsidy amounts shown during enrollment assume current law (meaning subsidies expire). If Congress extends subsidies after January 1st, marketplaces will adjust your premiums retroactively.
How much will my health insurance premiums increase without subsidies?
Average premiums increase 114% if enhanced subsidies expire, according to CMS data. Your specific increase depends on age, location, income, and plan type. A 45-year-old earning $55,000 might see monthly premiums jump from $250 to around $535. Families face steeper increases—a family of four earning $90,000 could see premiums rise from $450 to $963 monthly. Use your state marketplace calculator to estimate your exact increase based on 2026 household income.
Should I enroll in 2026 ACA coverage now or wait for Congress to decide on subsidies?
Enroll now during open enrollment. Most state marketplaces allow special enrollment periods if subsidy rules change after January 1st, letting you adjust or switch plans. If you wait and subsidies aren’t extended, you risk missing the enrollment deadline entirely and going uninsured for 2026. When enrolling, calculate premiums both with and without enhanced subsidies to understand your worst-case cost. Prioritize plans with lower monthly premiums if you’re concerned about paying full price.
What alternatives do I have if ACA subsidies expire and I can’t afford coverage?
Check Medicaid eligibility first—income limits vary by state, and some households qualify without realizing it. If you don’t qualify for Medicaid, consider high-deductible health plans paired with Health Savings Accounts, which offer lower monthly premiums but higher out-of-pocket costs. Some employers offer spousal coverage add-ons if your partner has workplace insurance. Short-term health plans provide limited coverage at lower costs but don’t meet ACA requirements and won’t protect you from the tax penalty in states that still enforce it. Community health centers offer sliding-scale care regardless of insurance status.
What is Dr. Oz’s role in the ACA subsidy extension decision?
Dr. Mehmet Oz, as CMS Administrator, oversees the agency implementing ACA marketplace operations but cannot unilaterally extend premium subsidies—that requires congressional legislation. His November 16th comments confirming “discussions” about extending subsidies reflect the Biden administration’s position and lobbying efforts toward Congress. CMS can adjust marketplace rules and provide guidance to insurers, but the actual subsidy extension depends entirely on whether Congress passes and the President signs legislation before December 31, 2025. Oz’s statements signal administration support but don’t guarantee action.
The Bottom Line: Plan for the Worst, Hope for Better
Dr. Oz’s confirmation that subsidy extension talks are happening is mildly reassuring. But “discussions” don’t pay your January premium.
Here’s what you need to do right now:
Enroll in 2026 marketplace coverage during open enrollment. Calculate your premiums assuming subsidies expire so you know the maximum you might pay. If that’s unaffordable, explore Medicaid eligibility or high-deductible plans with lower monthly costs. Check if your state offers extended enrollment deadlines or special provisions due to subsidy uncertainty.
The political reality: Congress might extend subsidies at the last minute like they’ve done before. Or they might not. You can’t control that outcome, but you can control whether you have health coverage on January 1st.
22 million Americans are gambling that Congress acts in time. Don’t be one of them without a backup plan.