An estimated 4 million Floridians who get their health insurance through the Affordable Care Act are about to see next year’s health premiums jump — with a median increase of about 18%, according to a national policy research organization.
And that premium percentage increase — about 11 percentage points greater than last year’s — doesn’t count the effect that most ACA enrollees will experience as individual federal subsidies for those premiums expire at the end of 2025 as expected.
The effects of the “big beautiful bill,” the administration’s megabill that rolled President Donald Trump’s administration priorities into one piece of legislation, is just one of several factors driving health premiums up for 2026 health plans purchased through the government-sponsored Healthcare Marketplace, according to the Peterson-KFF Health System Tracker, which monitors the performance of the nation’s health system according to quality and cost measures.
The tracker found that 312 insurers participating in ACA Healthcare Marketplaces had submitted proposals by this month for 2026 health plans that show the biggest premium jumps since 2018.
Premium increases for those buying their health insurance through the government-sponsored marketplace hit Florida harder than any other state. No other state has a higher proportion of residents getting their health care through the ACA Marketplace — 20%. And the vast majority of them are getting subsidies for their premiums.
What’s the ‘big, beautiful bill’?
The legislation that Trump signed July 4 is also advancing administration priorities such as beefing up border security, extending tax cuts from Trump’s first term and providing tax relief for Social Security recipients. But it also came with implications for Medicaid, a state-federal partnership providing health insurance for the neediest, and ACA enrollees, who are often self-employed without access to employer-based health care.
The administration noted that the bill’s changes to Medicaid will protect the health care benefit by removing 1.4 million “illegal immigrants who are gaming the system.” But it’s also going to affect a lot more people, according to the nonpartisan Congressional Budget Office. The office estimated the changes will result in 7.7 million people without health insurance by 2034.
More immediately, though, the budget did not renew enhanced federal subsidies for health care purchased through the ACA marketplace and those enhanced subsidies will expire at the end of 2025. As a result, insurers are expecting that healthier people will leave the insurance, the tracker found. That means enrollees are more likely to be less healthy and sicker on average. The flight is expected to drive about 4% of the increased premium for 2026 health plans.
Also driving the expected increase in 2026 health care insurance premiums: increased costs for labor, demand for specialty medications treating cancer, obesity and diabetes and tariffs, the tracker found.
What is this enhanced subsidy that’s expiring?
Anyone can get health care insurance through the Affordable Care Act, but the range of family incomes that qualify to get government subsidies for their premiums expanded under former President Joe Biden to include the middle class.
Some believe the expiration of the enhanced subsidies will be a game-changer for people without access to employer-sponsored insurance.
“It will shatter health care,” predicts Alexander Golubev, who turned to selling ACA policies full time last year through his agency, Atlantic Breeze Insurance in Hallandale Beach.
Parts of Hallandale Beach are included in a congressional district where one-third of the residents are enrolled in ACA and the vast majority receive enhanced subsidies for their health care premiums.
Golubev explained further: “Ninety-nine-point-nine-nine-nine-nine percent of the people I work with don’t have even $10 to spare every month for additional costs, if there are any for a health-care plan. Meanwhile, the subsidy is covering, you know, anywhere from $500 to $1,000 per person per month.”
Ann Berner, President and CEO of the Southeast Florida Behavioral Health Network, which develops and manages the addiction treatment network of providers in Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie counties, said that the oncoming expiration of ACA subsidies is causing great uncertainty among providers. Many of their patients get ACA subsidies, she said.
What role has the subsidy played?
Sign-ups for the latest ACA enrollment period in Florida hit a record in January. The number of enrollees receiving the government subsidies doubled between 2020 and 2024, according to an analysis from KFF, a national health policy research nonprofit.
With an eye to making health insurance affordable for low- to moderate-income enrollees without access to employer-sponsored health care, legislation made it so that ACA enrollees qualify for a government subsidy through the ACA Marketplace. The idea is that, with insurance, people will get preventive health care and not wait until a condition drives them to a hospital emergency room, which is a more expensive venue for healthcare.
Those making between 100% to 400% of the federal poverty level are eligible for the subsidies. For a family of four, that’s an annual income ranging from $32,150 to about $124,800.
Other qualifications include not having access to employer-sponsored health care, or an “affordable” plan that costs either equal to or less than 9.02% of one’s household income; ineligible for coverage under Medicare, Medicaid, or the Children’s Health Insurance Program; and proof of U.S. residency or legal residency.
On average, those who use the HealthCare.gov to get their ACA as Florida residents do, are now paying an average of $672 per year in 2024, or $56 per month. Without the subsidy, the average premium would rise by 93%, to $1,296, per year, KFF projects. And that’s not counting the increases showing in the base premium costs for 2026.
How have ACA subsidies been calculated?
ACA subsidies were enhanced in 2021, under Biden’s American Rescue Plan, which was passed as COVID-19 was raging. Then, in 2022, the subsidies were extended with the passage of the Inflation Reduction Act. Florida residents, collectively, account for $2.2 billion in enhanced subsidies because of the 2022 boost to ACA this year, KFF found.
The way it works, those who make less money get more of a subsidy. So the expiration of subsidies would hit those with lower incomes harder, according to KFF’s analysis.
A 30-year-old single person in South Florida making $15,650 — the lowest rung of ACA subsidy eligibility — will be paying $23 more per month for his or her health care premium if the enhanced subsidies expire but will still receive some help, according to a KFF calculator.
By contrast, that same person making $62,600, near the highest limit to be eligible for a subsidy, would be paying $8 more per month in premiums once the enhanced ACA subsidies expire.
Do ACA subsidies have to be paid back?
Generally, subsidies are not repaid to the government unless the recipient earned more than they projected when they enrolled at HealthCare.gov.
Where do the largest proportions of Florida ACA enrollees live?
Five congressional districts have more than a third of their population getting their health insurance through ACA, KFF’s findings show. Four of those five districts are in South Florida, mostly districts comprising Miami-Dade County, with one including a sliver of Broward County. One of them is in Central Florida.
Anne Geggis is the insurance reporter at The Palm Beach Post, part of the USA TODAY Florida Network. You can reach her at ageggis@gannett.com. Help support our journalism. Subscribe today
This article originally appeared on Palm Beach Post: ‘Big Beautiful Bill’ fallout: End of ACA subsidies will hike premiums about 18%
Reporting by Anne Geggis, Palm Beach Post / Palm Beach Post
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